What Causes Headache, Chest Tightness, Dry Cough, Dyspnea And Muscle Fatigue After Exercise?
Question: I am a 66 year old white male, non-smoker, minimal drinker, who is normally very physically active. Most significantly, when feeling healthy I bicycle recreationally 100-150 miles per week. I have noticed a gradual, mild loss of performance over the past 5 years or so as would be expected at my age, but over the past 3-4 months I have experienced an accelerated, fairly significant exercise intolerance at the high end (e.g., climbing longer, steeper hills). Symptoms with normal activity include fairly constant mild headache, a mild sense of chest tightness, mild mostly dry cough, and mild upper airway congestion. Symptoms with more intense exercise include moderate dyspnea, more rapid increase in muscle fatigue and decreased stamina compared to the past, and increased general fatigue in the 12-24 hours after exercise. While I can still bicycle at a moderate level for my age, this problem has noticeably affected the distance and speed at which I can ride and definitely reduced my enjoyment of the sport.
Other pertinent history: I have a history of 2 episodes of atrial fibrillation 30 and 20 years ago, with no recurrence. I have long-standing mild first-degree heart block on EKG. I have borderline essential hypertension, currently untreated. My resting HR is 60-66. 5 years ago my HR with maximal effort on the bicycle was typically 170-175; now it is 160-14, and the symptoms I described above become noticeable as my HR rises to around 150. My cholesterol, LDL, and HDL have always been well within normal limits.
Recent workup include CXR, blood chemistries, blood counts, Lyme screen, inflammatory screens, echocardiogram, and nuclear stress test; all have been reported as normal.
I would appreciate any thoughts you might have. Thank you.
Other pertinent history: I have a history of 2 episodes of atrial fibrillation 30 and 20 years ago, with no recurrence. I have long-standing mild first-degree heart block on EKG. I have borderline essential hypertension, currently untreated. My resting HR is 60-66. 5 years ago my HR with maximal effort on the bicycle was typically 170-175; now it is 160-14, and the symptoms I described above become noticeable as my HR rises to around 150. My cholesterol, LDL, and HDL have always been well within normal limits.
Recent workup include CXR, blood chemistries, blood counts, Lyme screen, inflammatory screens, echocardiogram, and nuclear stress test; all have been reported as normal.
I would appreciate any thoughts you might have. Thank you.
Brief Answer:
Get done PFT (Pulmonary Function Test) and HRCT thorax.
Detailed Answer:
Thanks for your question on Healthcare Magic.
I can understand your concern.
No need to worry for heart diseases as your extensive cardiac work up is normal.
In my opinion, we should definitely rule out pulmonary diseases (bronchitis and interstitial lung disease - ILD).
As both of them show gradually worsening dyspnea and reduced exercise tolerance.
So get done PFT (Pulmonary Function Test) and HRCT (high resolution CT) thorax.
PFT is must for the diagnosis of bronchitis.
HRCT is needed to rule out ILD.
Hope I have solved your query. I will be happy to help you further. Wish you good health. Thanks.
Get done PFT (Pulmonary Function Test) and HRCT thorax.
Detailed Answer:
Thanks for your question on Healthcare Magic.
I can understand your concern.
No need to worry for heart diseases as your extensive cardiac work up is normal.
In my opinion, we should definitely rule out pulmonary diseases (bronchitis and interstitial lung disease - ILD).
As both of them show gradually worsening dyspnea and reduced exercise tolerance.
So get done PFT (Pulmonary Function Test) and HRCT (high resolution CT) thorax.
PFT is must for the diagnosis of bronchitis.
HRCT is needed to rule out ILD.
Hope I have solved your query. I will be happy to help you further. Wish you good health. Thanks.
Above answer was peer-reviewed by :
Dr. Kampana
Thank you Dr. Bhavsar; I will discuss your suggestions with my primary care physician. If my problem is bronchitis, do you think there is any chance that there is a bacterial component that should be treated? My CBC was normal 2 weeks ago and I have not noticed any significant fever, but I do feel that my upper respiratory symptoms have become a bit worse in the past week or two.
Thanks.
Thanks.
Brief Answer:
Yes, you should get done repeat CBC and start antibiotic.
Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
Yes, you should definitely get done repeat CBC and start broad spectrum antibiotic like levofloxacin or azithromycin once a day for 5 days.
I am glad that my advice is helping you.
It's always encouraging for doctors to hear positive feedback from patients.
Hope I have solved your query. If you are not having further queries, then please close the conversation and rate my answer.
You can ask me directly on bit.ly/askdrkaushalbhavsar.
Wish you good health. Thanks.
Yes, you should get done repeat CBC and start antibiotic.
Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
Yes, you should definitely get done repeat CBC and start broad spectrum antibiotic like levofloxacin or azithromycin once a day for 5 days.
I am glad that my advice is helping you.
It's always encouraging for doctors to hear positive feedback from patients.
Hope I have solved your query. If you are not having further queries, then please close the conversation and rate my answer.
You can ask me directly on bit.ly/askdrkaushalbhavsar.
Wish you good health. Thanks.
Above answer was peer-reviewed by :
Dr. Yogesh D