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What Causes Tightness In Chest And Dizziness With Breathing Difficulty?

Posted on Fri, 27 Jun 2014

Question: my blood pressure is normal, but every time I vaccuum or walk a few blocks, I feel tightness in my chest and dizziness and almost out of breath.

Answered by Dr. Anantharamakrishnan (2 hours later)

Brief Answer:
Need investigations

Detailed Answer:
Dear friend,
Welcome to Health Care Magic

You should discuss with your Internist

     Chest tightness and/or breathlessness, related to effort should be investigated for Coronary Artery Disease. See a Cardiologist / get yourself examined / investigation will be necessary...
     EKG / HOLTER (24 to 48 hour ambulatory monitoring) / ECHOcardiogram / TMT (Treadmill exercise ECG) / LABORATORY work-up – may all be necessary for further assessment and assistance. If the routine EKG is normal, it is better to have a Treadmill Exercise Electrocardiogram (TMT).

     If there are no clues, you ought to see a Pulmonologist (Lung specialist) – X-ray chest & Spirometry (Lung function) tests will be in order.

The treating doctor may suggest further depending on need, based on his assessment of the situation. Prognosis is good at this age...

Take care
Good luck

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Anantharamakrishnan (40 minutes later)

Prior to having my 3rd child, my blood pressure has been always within the 90/60 range. I do understand I am a lot older now and that I have 40 pounds extra that I didn't have before having my first child. (I hear that from my Dr. at every check up). In the last 5-7 years I have had about 5 EKG's and luckily always normal. I did have halter monitor a few years ago which recorded some irregularities. I have five children, ages 3, 5, 9, 12, and 14. I am under a lot of stress and I weigh 160 lbs based on last weeks follow up. At that check up my blood pressure was 150 not sure of diastolic which prompted my Dr to change my medicine from regular lisinopril 20 mg to lisinopril-hctz 10-12.5 mg. I also take gemfibrozil - she found good cholesterol was great, but my bad cholesterol too high again. I due suffer from anxiety and major depressive disorder and I take Remeron. I have never seen a cardiologist nor a lung specialist, I thank you for the suggestion. My doctor thinks it is probably from depression, stress or anxiety what I am experiencing. So, sometimes it is hard to get her to listen to me when I say what I am experiencing is different. If I vacuum a room of 15'x12', or drink water fast, walk for a few blocks, I feel short of breath, dizzy and tightness in my chest. If I bend to go under the table to pick up something, on the way back up I feel tightness and lightheaded. My blood pressure monitor has readings under 130/90, but at least once a week records an irregular heartbeat. When I feel anxiety, it feels different...like a panic that I have to move or hide..this is more like it stops me in my tracks and I need to sit, close my eyes. I do get scared, but it is a different type of scary...not anxiety or panic attack scary.

Answered by Dr. Anantharamakrishnan (44 minutes later)

Brief Answer:
Investigate to exclude & reassure..

Detailed Answer:
Hi
A normal ECG is reassuring / however a stress ECG is necessary to exclude

     Blood pressure tends to rise with age / most people need more than 2 drugs to control
The maximum dose of Lisinopril is up to 40 mg; it can be stepped up later – depending on the level of pressure / Generally, we keep the dose of HCTZ same / You are in good hands; your doctor has done the right thing

     Gemfibrosil manages triglycerides better than cholesterol / it may be replaced by a statin, if necessary. Life style changes are equally important – diet & exercise; no tobacco or alcohol…

     Dizziness is vague term - unsteadiness. If there is definite sense of rotation, it is called vertigo. If it is from getting up from bed, it may be from postural hypo-tension.. Did you check your BP – standing and lying? / It can be from anaemia – what is your haemoglobin? The body's balancing mechanism is in the inner ear. An ENT (Ear Nose Throat) specialist is the one to see - they have special tests to confirm or exclude the contribution of the ear. This is particularly important if there is tinnitus.

     Indeed, Anxiety could explain all the features… yet, we generally make it an exclusion diagnosis… Stress EKG is an important help in this regard. If it is only Anxiety – the drug or the dose may be modified…      Anxiety cause arrhythmia > Arrhythmia causes anxiety > a vicious cycle sets in. Many cases of palpitation are benign, especially when associated with normal ECHO and may not require treatment. Drugs like Beta-blockers are useful in such situations – they have multiple benefits and help in blood pressure, anxiety, arrhythmia and so on..
     The tests are meant to rule out anything. Heart disease is not at all common in women and at this age. Be positive. All has been well till now / will be well in future too. Take things easy. At the same time, practice relaxation exercises, bio-feedback, yoga and so on.

Regards

Note: For further queries related to coronary artery disease and prevention, click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar