Chest Pain and Breathing Difficulties: When to Seek Help

Shortness of breath and chest pain?

Hello, I would like to consult a doctor.
About a year ago, I experienced a strong, penetrating pain in the center of my chest that lasted for several days and prevented me from sleeping.
I saw a pulmonologist who took an X-ray and suggested it might be a musculoskeletal issue, indicating that there was no major problem.
However, for the past three months, I have been experiencing a sensation of not being able to breathe properly, as if being compressed.
This feeling sometimes occurs with minimal physical activity, such as walking short distances or climbing four flights of stairs, but often happens even when I am at rest.
It occurs almost daily, one to two times a day.
Initially, I thought it was due to the heat, but it also happens in air-conditioned rooms or outdoors at night.
When I feel this way, I also experience fatigue, weakness, and sometimes a sensation of lightheadedness or nausea.
I consulted a pulmonologist again, who took another X-ray and said everything was normal.
Additionally, recently, I have been feeling an itch in my trachea with each deep breath, which has led to some mild coughing.
Occasionally, I also feel pain in the area of the sternum.
I would like to ask which other specialties I should consider consulting, or what other possibilities there might be.
I have suspected issues such as lack of exercise, slight kyphosis, early heart failure, or autonomic nervous system problems.
Could any of these be the cause?

Mr. Li, 30~39 year old female. Ask Date: 2018/08/21

Dr. Chen Junwei reply Pulmonology

It is recommended that you discuss with your attending physician whether to undergo further relevant examinations.
Wishing you good health.

Reply Date: 2018/08/21

More Info

Chest pain and breathing difficulties can be alarming symptoms, and it's understandable that you're seeking clarity on these issues. Given your description of symptoms, it's crucial to approach this matter comprehensively, considering both physical and psychological factors.

Firstly, the sensation of chest pain, especially if it feels like a piercing or constricting pain, can stem from various causes. As you've already consulted with a pulmonologist and undergone X-rays that returned normal results, it’s essential to consider other potential avenues. Conditions such as musculoskeletal issues, gastroesophageal reflux disease (GERD), anxiety, or even cardiac-related problems could be contributing to your symptoms.

1. Musculoskeletal Issues: If the pain is localized and exacerbated by movement or certain positions, it could be related to muscle strain or rib dysfunction. This is particularly plausible if you have a history of physical activity that might have led to strain.

2. Gastroesophageal Reflux Disease (GERD): This condition can cause chest pain that mimics heart-related issues. Symptoms often include a burning sensation in the chest, especially after eating or when lying down. If you notice that certain foods trigger your symptoms, it might be worth discussing this with a gastroenterologist.

3. Anxiety and Stress: Psychological factors can significantly impact physical health. Anxiety can lead to hyperventilation, which may cause sensations of breathlessness and chest tightness. If you find that your symptoms worsen during stressful situations or are accompanied by feelings of panic, this could be a contributing factor.

4. Cardiac Concerns: Although your X-rays were normal, it’s essential to rule out any cardiac issues, especially if you experience symptoms like fatigue, dizziness, or nausea. A thorough evaluation by a cardiologist, including an electrocardiogram (EKG) and possibly an echocardiogram, may be warranted to assess your heart's function.

5. Pulmonary Issues: While you mentioned seeing a pulmonologist, if your symptoms persist, consider asking for further testing, such as pulmonary function tests or a CT scan of the chest, to rule out conditions like asthma or chronic obstructive pulmonary disease (COPD).

6. Posture and Physical Activity: You mentioned concerns about posture and lack of exercise. Poor posture can lead to musculoskeletal pain and may contribute to feelings of breathlessness. Engaging in regular, gentle exercise, such as walking or yoga, can improve your overall physical condition and potentially alleviate some symptoms.

7. Self-Care and Monitoring: Keeping a symptom diary can help identify triggers or patterns in your symptoms. Note when the pain occurs, its intensity, and any associated activities or stressors. This information can be valuable for your healthcare provider.

In conclusion, while your initial evaluations have not indicated a serious underlying condition, the persistence of your symptoms warrants further investigation. Consider consulting with a cardiologist and possibly a gastroenterologist to explore all potential causes. Additionally, addressing any psychological factors through counseling or stress management techniques may also be beneficial. Remember, it's essential to advocate for your health and seek further evaluations until you find the answers you need.

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