Chest Tightness and Breathing Difficulties: A Patient's Journey

Q: Chest Tightness and Breathing Difficulties: A Patient's Journey

Hello： I believe that during the fever phase, it might be a gastrointestinal flu, with symptoms like increased heart rate. <br>Later on, I became very concerned about chest tightness and felt uneasy, which inevitably included some anxiety. <br>I suggest starting with anti-anxiety

First episode of chest tightness and difficulty breathing?

I have a long-term allergy condition (due to sinusitis).
On November 16 (Monday), I visited a general clinic for ENT (at that time, I was also experiencing a mild cough, cold, and fever).
Starting from November 18 (Wednesday), I began eating spicy food and drinking black coffee every morning.
On Thursday and Friday, I went to bed feeling very full, and I usually had my first meal around noon or later.
After dinner on Friday, I felt increased chest tightness and difficulty breathing.
On Saturday, I had my first meal in the afternoon and had bread and coffee for dinner (prior to this, I had been gradually experiencing chest tightness and breathing difficulties).
After taking a shower two hours later, I felt even more chest tightness and difficulty breathing, and I even felt dizzy, so I immediately went to the emergency room.
It was discovered that I had a fever over 38°C and a rapid heart rate of 140.
Later, I underwent tests including X-rays, blood tests, urinalysis, electrocardiogram, and blood pressure checks, all of which the doctor said were normal.
However, while in the observation room, I wore an oxygen mask and still felt difficulty breathing.
The doctor later suggested that I might have gastroesophageal reflux disease (GERD).

On November 22 (Sunday), after eating, I started experiencing chest tightness and difficulty breathing again, so I went to the emergency room.
This time, they administered saline and a sedative.
The doctor told me that I might have been bedridden at home without adequate exercise, which could have caused my gastrointestinal tract to become inactive, leading to gastroesophageal reflux and subsequent breathing difficulties.
Afterward, I consulted an infectious disease specialist but could not find a cause.
I then saw a gastroenterologist who suspected acute gastroenteritis, which could explain the fever, diarrhea, and nausea.
He concluded that I was less likely to have GERD.
That same evening, after only drinking electrolyte solution, I experienced chest tightness and difficulty breathing again.
I went to see a pulmonologist, who performed a second X-ray and said everything looked fine.
He listened to my breathing with a stethoscope and said it sounded normal, but when he measured my heart rate, he noted it was very fast.
He later diagnosed me with anxiety disorder and prescribed medication for it.
That night, I discovered that my menstrual period had started.
I ate a slice of white bread and took medication for gastrointestinal inflammation, but I began experiencing chest tightness and difficulty breathing again.
I immediately took the anti-anxiety medication, and after 20 minutes, I felt much better.
However, I am unsure whether it was due to the onset of my period or the anxiety medication that helped.
This was my first experience with chest tightness and difficulty breathing.
If it is anxiety, I am not sure what I am anxious about, as I started having symptoms on Thursday.
If there is any real anxiety, it might have started on the day I went to the emergency room! Previously, during my menstrual period, I only experienced breast tenderness, and everything else was fine.
When my period comes, I usually experience severe abdominal pain shortly after eating, but I feel better after vomiting.
Now, I am unsure whether my symptoms are related to my stomach, my menstrual cycle, or anxiety affecting my chest tightness and breathing difficulties.
(I later realized that the chest tightness and difficulty breathing became significantly worse after eating.
I have been on medication for three days, but the symptoms remain the same.) I don't know what to do now.

Jie, 20~29 year old female. Ask Date: 2020/11/25

Dr. Yang Wenda reply Pulmonology

Hello: I believe that during the fever phase, it might be a gastrointestinal flu, with symptoms like increased heart rate.
Later on, I became very concerned about chest tightness and felt uneasy, which inevitably included some anxiety.
I suggest starting with anti-anxiety medication and gastrointestinal medication.
If there is no improvement, an endoscopy may be considered.
During this period, it is advisable to avoid sweets and greasy or fried foods!

Reply Date: 2020/11/25

More Info

Understanding chest tightness and breathing difficulties can be a complex journey, especially when multiple factors such as allergies, gastrointestinal issues, and anxiety come into play. Based on your description, it seems you have been experiencing a range of symptoms that have led to significant distress and confusion regarding their origins.

Firstly, your long-standing history of nasal allergies and sinusitis can contribute to respiratory issues. Allergies can lead to inflammation in the nasal passages, which may cause post-nasal drip, leading to coughing and discomfort in the chest. This inflammation can also exacerbate any underlying respiratory conditions, potentially leading to feelings of tightness in the chest and difficulty breathing.

The timeline of your symptoms suggests a potential link between your eating habits and the onset of your breathing difficulties. Eating large meals, especially those that are spicy or acidic, can trigger gastroesophageal reflux disease (GERD), where stomach acid flows back into the esophagus. This can cause not only heartburn but also chest tightness and breathing difficulties, as the acid can irritate the esophagus and even the airways. Your experience of worsening symptoms after meals aligns with this possibility.

Moreover, the acute episodes of chest tightness and difficulty breathing that led you to the emergency room, coupled with a rapid heart rate, could also indicate anxiety or panic attacks. Anxiety can manifest physically, leading to symptoms such as hyperventilation, which can cause feelings of breathlessness and chest discomfort. The fact that you felt better after taking anti-anxiety medication suggests that anxiety could be a significant contributing factor to your symptoms.

It is also important to consider the role of your menstrual cycle in your symptoms. Hormonal fluctuations can affect gastrointestinal motility and may exacerbate symptoms of GERD or anxiety. If you notice a pattern where your symptoms worsen around your menstrual cycle, it may be worth discussing this with your healthcare provider.

Given the complexity of your symptoms, it would be beneficial to take a multi-faceted approach to management. Here are some recommendations:
1. Dietary Modifications: Consider keeping a food diary to identify any specific triggers that worsen your symptoms. Eating smaller, more frequent meals rather than large ones may help reduce the likelihood of reflux. Avoiding spicy, acidic, and caffeinated foods and beverages, especially close to bedtime, may also be beneficial.

2. Managing Allergies: Continue to manage your nasal allergies with appropriate medications, such as antihistamines or nasal corticosteroids, as prescribed by your healthcare provider. This may help reduce post-nasal drip and associated respiratory symptoms.

3. Anxiety Management: Since anxiety appears to play a role in your symptoms, consider exploring relaxation techniques such as deep breathing exercises, mindfulness, or cognitive-behavioral therapy (CBT). These can help you manage anxiety and reduce the frequency and intensity of panic attacks.

4. Regular Follow-ups: Keep in close contact with your healthcare providers, including your primary care physician, gastroenterologist, and possibly a mental health professional. Regular follow-ups can help monitor your symptoms and adjust treatment plans as necessary.

5. Physical Activity: Engage in regular, moderate physical activity, as tolerated. Exercise can help reduce anxiety and improve overall respiratory function. However, listen to your body and avoid overexertion, especially if you experience symptoms.

6. Further Evaluation: If symptoms persist despite these interventions, further evaluation may be warranted. This could include testing for conditions such as asthma, GERD, or other gastrointestinal issues, as well as a thorough assessment of your anxiety levels.

In summary, your journey through chest tightness and breathing difficulties involves a combination of allergic, gastrointestinal, and psychological factors. By addressing each of these areas, you can work towards alleviating your symptoms and improving your overall quality of life. Always consult with your healthcare provider before making any significant changes to your treatment plan.

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