Hello thanks for posting at HCM. Your symptoms like shortness of breath, loss of weight, chest pressure, fatigue can be symptoms of anemia. But since you have worked up, I guess haemoglobin levels would have been checked and found normal. Another possibility is chest infection . You have mentioned that tests are normal, but not which tests have been done. I want to know whether a chest x ray and a CT of the chest has been done. If not please get a CT chest done. It will show if you have some infection patches in the lungs. If infection patches are present, samples from those areas can be taken by bronchoscopy for testing. Possibility of tuberculosis should also be considered here. Since your ANA is positive then the symptoms can be due to autoimmune disease also. But again it depends on the intensity of ANA, its final dilution and its pattern. Please share information about the full ANA report. ANA positivity can affect lungs, kidneys and other organs also. Please do a urine routine and creatinine (if not already done) to see if kidney functions are affected. Please revert with the above findings. Wishing you good health Regards