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oxygen saturations

I am a 47 year old female with a 3 year history of progressive shortness of breath with exertion, some chest congestion and difficulty getting air in when walking, periodic unproductive cough.  The only abnormality found was an elevated pressure on echo of 48. RHC was done and was 18/8, normal. I have been tested over the last few years for asthma, heart disease, even mental illness but everything is negative.My breathing has gotten worse in the last few months especially after going to the gym to do light exercise. It is like a switch goes off, I turn into an irritable bear. My family doc asked me to do a walking oximetry (Iam an RN in a hospital). My sats dropped to 81%. She then came to my office the next day and walked around with me with an oximeter and it dropped to 85%. She got me into a specialist the next day and my sats were normal. He did a lung scan and it was normal. That is where I am left. I worry about the previous readings. Can a saturation change from abnormal one day and back to normal the next and there not be a problem? Any suggestions? My last echo 6 months ago showed the same pressure of 48 and all measurements normal so the specialist said I absolutely do not have PH.
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242587 tn?1355424110
MEDICAL PROFESSIONAL
The key to your problem may reside in the phrase, “difficulty getting air in.”  Trouble  getting air in (as opposed to getting air out is most often associated with what is referred to as Upper Airway Obstruction .  The Upper Airway extends from the nose or mouth to the end of the trachea (windpipe), where it divides, to enter the right and the left lungs.

A common site of obstruction is the larynx (voice box) including, but not limited to the vocal cords.  Obstruction is characterized as fixed (consistently present) or variable (present some of the time, somewhat unpredictably).  A condition, called Vocal Cord Dysfunction (VCD), is seen when the vocal cords close, rather than remaining wide open during inhalation (as they normally do).  Without a careful history and complete Spirometry (including what are called flow/volume loops), this condition can easily be mistaken for asthma.  If the flow/volume loops are not examined, simple Spirometry values (the deep breath and the amount exhaled in one second, could both be normal, and misleading)

Similar symptoms can occur with partial or complete paralysis of one or both vocal cords.  If the obstruction is variable, both your symptoms and the abnormal oximetry readings could vary from one day to the next.  Another explanation could be a faulty oximeter, either the one showing normal or abnormal values.

Other causes of upper airway obstruction at sites below the vocal cords include tumors (benign and malignant), tracheomalacia (collapse of airways), inflammation and even enlarged lymph nodes within the chest.  If your problem truly is either totally or predominantly getting air in, , or both in and out, then you should have direct examination of your upper and your lower airways by a lung specialist (pulmonologist), using an instrument called a fiberoptic bronchoscope.

I’m not sure what the ECHO pressure of 48 refers to.  If it is pulmonary artery pressure, that would be consistent with pulmonary hypertension.  Pressure measured with a RHC is the more reliable measure, however, and a pressure of 18/8 is well within the normal range.  That and the normal lung scan would be strong evidence against the diagnosis of pulmonary emboli (clots to the lungs).

The changes in oximetry values from day to day could occur with variable obstruction, either asthma or upper airway obstruction, but if this were the case, I would expect you to experience difficulty breathing at the time of low values.  With your request for information, you make no mention of having had Spirometry.  If not performed, it should be (see above regarding flow volume loops)

It is important that whatever testing is required, of heart or lung function, be performed now and the results be determined to be valid.  Lung diseases are not the only cause of low oxygen saturations.  A reduction in saturation can occur with heart conditions that result in the heart not pumping normally(this probably ruled out by the normal ECHO) or by what is called shunting of blood within the heart.  Such shunts can also be found in the lungs.

You might want to share this response with your lung specialist, to stimulate further discussion of other possible causes.

Good luck
Helpful - 1
Avatar universal
Thank you for the very informative answer. I will definitely show my physician. I had incorrectly documented the RHC pressure as 18/8. The mean pressure was 18 as the readings were actually 30/8. From what I have read that is still within normal limits but on the upper end. I don't know if that is significant or not. When my saturations have dropped, I am experiencing shortness of breath. I only get SOB with exertion which is becoming increasingly more consistent. By the end of a work week, I feel pretty poorly so my weekends, I have to rest in order to start half way felling well on Monday.
  I have had pulmonary function testing. Not sure about the flow volume loop part though. All measurements were normal and even improved from a year ago except the DLCO which was lower but still within normal limts.
  I have baffled my physician so this may be of benefit. I am just concerned about the saturations so hopefully, they were wrong readings. Thanks again.
Helpful - 1
180749 tn?1443595232
Do this yog pranayam technique and it will help to get oxygen level towards normal. You will notice the difference in days.Come back to report your progress.
Build up your timing gradually.If you feel tired or dizzy, stop and resume after one minute.
Kapalbhati -(Do it before eating) Push air forcefully out through the nose about once per second. Stomach will itself go in(contract in). The breathing in(through the nose) will happen automatically. Establish a rhythm and do for 20 to 30 minutes twice a day. Children under 15 years – do 5 to 10 minutes twice a day.
Not for pregnant women. Seriously ill people do it gently.
Anulom Vilom –
Close your right nostril with thumb and deep breath-in through left nostril  
then – close left nostril with two fingers and breath-out through right nostril  
then -keeping the left nostril closed  deep breath-in through right nostril
then - close your right nostril with thumb and breath-out through left nostril.
This is one cycle of anulom vilom.
Repeat this cycle for 15 to 30  minutes twice a day.
Children under 15 years – do 5 to 10 minutes twice a day.
You can do this before breakfast/lunch/dinner or before bedtime or in bed.Remember to take deep long breaths into the lungs.You can do this while sitting on floor or chair or lying in bed.
Helpful - 0

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