Unexplained shortness of breath for months, worried about Pulmonary Fibrosis

[dale25]

Hello, I did not know where else to post this question. Essentially this all started 2 1/2 months ago when suddenly I was extremely short of breath after exercise, I went from being able to walk nearly 3 miles  day to not being able to walk more than a few blocks without feeling very uncomfortable and short of breath.

The feeling is essentially that i can't get a deep breath, some days are worse than others but altogether exercise is almost always intolerable. I had a full cardiovascular workup which was normal except I do have high blood pressure which is currently under treatment.  I should add that I am a 23 year old male 5,11 195 lbs.

  Some days getting a breath is extremely difficult, anyway I am very worried because I have been reading about Pulmonary Fibrosis and am worried I have it.

I went to a pulmonologist who did the following tests 2 xrays 1 month apart that came back as normal.  I also did a PFT test which he said was good and didn't need to do further testing to rule out PF.  He also listened to my lungs and they sounded fine, my pulse ox is 99.  He diagnosed me with anxiety and sent me on my way.

Firstly as far as i know anxiety CANNOT CAUSE CHRONIC SHORTNESS OF BREATH OR SHORTNESS OF BREATH DURING EXERCISE!

Can I still have pulmonary fibrosis or should I trust the pulmonologist at this point? I am literally bedridden except for buying food and going to the bathroom. Sometimes the shortness of breath gets downright scary and I feel like I need to go to the ER but I have gone 3 times and my pulse ox is always 99-100% I usually get sent home with the diagnosis of "Panic attack" but I don't feel panicky, I feel frustrated however.

Could this be PF? What do you think?  Also, D-dimer and echocardiogram were normal.

Thank you

PS- I apologize for the frantic nature of this post, I am sick of feeling this way

[David Tinkelman, M.D.]

The normal chest X-ray, in conjunction with normal PFT’s, the normal or hyper-normal oxygen saturations and the negative D-dimer effectively rule out the diagnosis of interstitial lung disease, COPD and clots to the lungs (pulmonary emboli); actually rule-out any lung disease as a cause of your exercise related shortness of breath.

Two possibilities in addition to anxiety/panic come to mind:  Vocal cord dysfunction (often not tested for on PFT’s and occult heart disease.

A physician-supervised treadmill exercise study and PFT with what is called an inspiratory flow=volume loop followed by direct fiberoptic examination of your vocal cords would help clarify the preceding, above and would also address the question of heart disease (abnormal heart rhythm or disease of the cardiac muscle.

Please be aware that one may not experience overt signs of anxiety, yet still having a Panic Disorder with can feel every bit like the shortness of breath that accompanies heart or lung disease.

Discuss the preceding with your pulmonologist.

[dale25]

Also the shortness of breath is at rest too, all day. Does that change anything?

[dale25]

Thank you for your response Dr, it is much appreciated.  I never considered vocal cord dysfunction.

I should have added that on my first hospital visit my first EKG suggested right atrial abnormality as well as Ventricular Hypertrophy, however 2 follow up echocardiograms showed nothing at all. My echocardiogram also showed normal pulmonary pressures.

I just had a few more questions if you have the time "If not I understand and you are a true Mensch for getting back to me on these extremely troubling symptoms".

1. About 3 weeks prior to all these symptoms I was prescribed "Toprol XL 25mg" for fast heart rate and was wondering if this could possible have contributed to the shortness of breath.  However I took a 1 week break from the drug and still had SOB, is 1 week enough to tell whether or not the SOB is coming from the drug itself?

2. Regarding occult heart disease, I booked an electrophysiologist study that I will be taking on the 31st of this month to check for the heart rhythm abnormalities that you suggested.  However I am worried that with my beta blocker intake it is unlikely that any tachycardic/abnormal rhythms will be picked up, is this unfounded? Also does my normal echocardiogram rule out heart failure? And specifically what occult heart disease is most common in my age group that also causes SOB?

3. I have trouble sleeping now as I wake up gasping or am often unable to fall asleep because of the horrible feeling of breathlesness, does this plus the sudden exercise intolerance suggest any disease?

Again thank you 100000x, no matter what happens I will post my results here on Medhelp, whether or not I get a resolution. I think it is important to keep the community updated as I can see I am not the only person suffering from this troubling symptom.

[dale25]

I'd like to add if I didn't make it clear that this problem is CHRONIC, however some days are certainly much worse than others. Not sure if this helps me one way or the other.