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Suggest Treatment For Shortness Of Breath Upon Exertion

Posted on Mon, 22 Jun 2015

Question: I am a 78 year old female who has AFib which is controlled with medication. I also have moderate pulmonary hypertension. I have mild anxiety and I take one half Xanax in AM and one whole in PM, which is 0.25 mg tablets, which is a very low dose. I wear a pacemaker ( 3 years) and also have had two ASD closures...one quite large which required side braces to close. I have hypothyroidids (mild) and take Synthroid. My problem that I wish to address to you is: I sometimes have a "catch" in my breath which leads to maybe a second of "feel good" feeling. This can happen anytime and I have no warning. I also have shortness of breath upon exertion. I was placed on oxygen but this made my symptoms worse. I have been off oxygen (1 and 1/2 L) for 3 weeks and feel much better off the oxygen. One doctor put me on the oxygen and another one said I don't need it. My question tonight is, why do I get this catch in my breath. If it lasted too long I could pass out. I live alone.. Thank you, XXX

Answered by Dr. Noble Zachariah (3 hours later)

Brief Answer:
A pulse oximetry monitoring advisable.

Detailed Answer:
Hello Ms. XXXX

Welcome and thanks for your query.
I understand your concern. As you are living alone it is important to know whether the catch in your breath is significant or not. Does this occur during your wake time or during sleep? If in the sleep, it is sleep apnoea and there can be either central causes arising in the brain or from obstructive sleep apnoea which is commoner in people who are obese. The feeling of a catch during wake hours with no sleep apnoea usually occurs in anxious people and another cause is rarely found in my patients who have undergone extensive investigations and tests.
The easiest way to know whether these catches are dangerous or not, is to have your heart rate and oxygen saturation measured over a period of time and see what changes in the same occur when you have these catches. It is easily done with a wearable 24 hour pulse oximetry monitoring device. If your doctor does not have one, you can even buy one online. It is not expensive and comes with the software to analyse it.
If you have any difficulty in interpreting the result, I shall be happy to do it for you.
Wish you good health.
Dr Noble Zachariah

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Noble Zachariah (12 hours later)

I have a pulse oximetry device and my oxygen levels are in the approval range. I will take the Xanax daily as I have tried to back off from taking them and even contemplated trying to go off them altogether. However, since this is an anxiety problem, what medication would you suggest for treatment. I have tried Clonopin and it is not for me. Sometimes the Xanax causes me to feel very tired.... I have, since last night, practiced the correct breathing techniques, with breathing more deeply from the stomach instead of the chest. Thanks, XXX

Answered by Dr. Noble Zachariah (15 hours later)

Brief Answer:
you could request your doctor for a SSRI

Detailed Answer:
Sorry for the delay in replying.
It is good to take deep breathes and exhale through pursed lips slowly. This will help to improve the oxygenation and reduce the anxiety.
You could request your doctor to consider a SSRI like Escitalopram which is helpful for both anxiety and depression.
This does not produce habituation like Xanax and you would be able to come off Xanax gradually.
Best wishes,

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Noble Zachariah (2 days later)

Thank you very much...I see my doctor next Tuesday and will ask him to prescribe the escitalopram for anxiety and depression...XXXX

Answered by Dr. Noble Zachariah (21 minutes later)

Brief Answer:
Welcome

Detailed Answer:
Thank you.
Hope you will be immensely benefited and be well soon.
Wish you good health and a great day

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Noble Zachariah (6 days later)

I wear a pacemaker...Can I have electrolysis on a couple of ingrown hairs on my face? Can I have permanent makeup done on my face? Will either of these affect my pacemaker? I hope not because I want them done, especially the permanent makeup...Thanks, XXXX

Answered by Dr. Noble Zachariah (5 hours later)

Brief Answer:
Can be done cautiously.

Detailed Answer:
Welcome back.
Electrolysis can be done carefully and cautiously if you have a pacemaker. I am sorry I am not sure as to what is done in permanent make up.
If the permanent make up involves only use of chemicals and not of any machine using radio frequency waves, it can be done.

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Noble Zachariah (3 days later)

I love this answer and question method via computer! My next question is: The Lexapro made me irritable and sleepy. I felt really "out of it". Is there a milder one I could try? Also, my shortness of breath has taken a new turn and I wake up in the middle of the night sometimes 2 or 3 times with a horrible nightmare and am holding my breath or not breathing to the point of serious. Oxygen, as explained made me feel very sick so I am no longer on it. Can you suggest what the night episodes may be? am afraid to go to bed at night...Thanks...XXXX

Answered by Dr. Noble Zachariah (2 hours later)

Brief Answer:
Possibility of sleep apnea or orthopnea

Detailed Answer:
I am glad that you find this service helpful.
Lexpro is one of the safest and simplest. The irritation and sleepiness can be the side effects. The way to tackle it is to reduce the dose. I don't know what dose you are on. You can start with 5mg with your lunch or dinner ( you may have to divide a 10 mg tablet ) and then build up the dose depending on the need.
Next time you have a nightmare check your pulse oximetry and let me know the SPO2 and heart rate. If you have a continuous recorder, please send me a night record and I would be able to advise you better.
In the mean time, sleep on the side with your head end of the bed elevated and see if it makes a difference.
Best wishes ,

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Above answer was peer-reviewed by : Dr. Shanthi.E