Chest Tightness in Hyperthyroidism and Heart Valve Issues

Chest tightness issue?

Hello, doctor.
I am a patient with hyperthyroidism, and my only symptom is a slightly elevated heart rate.
I also have a problem with mitral valve insufficiency.
Currently, I am controlling my hyperthyroidism with medication, taking two tablets of methimazole in the morning and evening, along with one medication to lower my heart rate.
Unless I stayed up late the previous night, my heart rate has been reduced to between 60 and 80 beats per minute, which is considered normal.
However, I don't understand why, even with a normal heart rate, I still experience chest tightness and difficulty breathing in the morning.
I often feel the need to take deep breaths but feel like I can't get enough air into my lungs.
This situation is particularly noticeable when I have eaten too much or when the weather is hot and humid.
However, after resting in an air-conditioned room for an hour or two, I feel relief.
I have visited the emergency room, had my lungs examined, and underwent an electrocardiogram.
The emergency physician observed my breathing and indicated that there were no issues.
The cardiologist also reviewed the electrocardiogram and deemed it to be normal, albeit slightly elevated.
This issue has persisted for many years, and the discomfort has become more pronounced as I age.
I initially felt improvement after starting a regular exercise routine, but with the recent hot and humid weather, I have begun to feel uncomfortable again.
Could this be simply due to poor cardiopulmonary function, or is it related to my hyperthyroidism? Would increasing the intensity of my exercise help improve my breathing? Thank you for your response, doctor.

Niming, 40~49 year old female. Ask Date: 2021/06/21

Dr. Hong Yuanbin reply Internal Medicine

Hello, based on your description, there could indeed be many causes for your breathing difficulties.
It may be necessary to check your blood oxygen levels; if they are abnormal, you should be cautious about potential lung or heart issues.
However, since you have already undergone relevant tests and they are normal, we should consider whether thyroid issues might be contributing.
I recommend discussing this with your endocrinologist, as you may need to test your thyroid hormones for confirmation.
Additionally, you mentioned that the symptoms occur after meals; some individuals may experience shortness of breath due to diaphragm elevation or gastroesophageal reflux disease (GERD) after eating.
This should be evaluated by a gastroenterologist.
If all the above tests are normal, it may indeed be related to poor cardiopulmonary function or psychological factors, which can improve with exercise.
Thank you for your inquiry.

Reply Date: 2021/06/21

More Info

Understanding chest tightness in the context of hyperthyroidism and heart valve issues can be complex, as both conditions can significantly affect cardiovascular health and respiratory function.
Hyperthyroidism, characterized by an overactive thyroid gland, can lead to an increased heart rate (tachycardia), anxiety, and a range of other symptoms. The thyroid hormone plays a crucial role in regulating metabolism, and when levels are elevated, the body may respond with heightened cardiovascular activity. This can manifest as palpitations or a rapid heartbeat, which you have already noted. The medications you are taking, such as methimazole (Li-Jia), are aimed at controlling thyroid hormone production, and beta-blockers can help manage heart rate and alleviate symptoms like anxiety and palpitations.

Your experience of chest tightness and difficulty breathing, particularly in the morning or after eating, raises several considerations. First, it is important to recognize that even when heart rate is within a normal range, other factors can contribute to feelings of discomfort. For instance, anxiety and stress can exacerbate sensations of tightness in the chest and difficulty breathing. Additionally, the presence of mitral valve insufficiency (or regurgitation) can lead to inefficient blood flow and may cause symptoms such as shortness of breath, especially during exertion or when lying flat.

The fact that your symptoms improve in a cool environment suggests that heat and humidity may be aggravating your condition. High temperatures can lead to dehydration and increased heart rate, which may exacerbate feelings of breathlessness. It is also worth noting that after eating, blood flow is redirected to the digestive system, which can temporarily reduce blood flow to other areas, including the heart and lungs, potentially leading to feelings of tightness or discomfort.

Regarding your question about whether this is simply a result of poor cardiopulmonary function or related to hyperthyroidism, it is likely a combination of both. Hyperthyroidism can lead to increased oxygen demand and a higher heart rate, which may not always be met with adequate oxygen supply, especially if there are underlying heart valve issues.
Increasing your exercise intensity can indeed help improve overall cardiovascular and respiratory function. Regular physical activity strengthens the heart muscle, improves circulation, and enhances lung capacity, which can alleviate symptoms over time. However, it is essential to approach this gradually, especially considering your history of heart valve issues and hyperthyroidism. Consulting with your healthcare provider before making significant changes to your exercise routine is advisable.

In summary, your symptoms of chest tightness and difficulty breathing are likely multifactorial, involving both your hyperthyroidism and heart valve condition. Continued monitoring of your thyroid levels, adherence to your medication regimen, and a gradual increase in physical activity, along with attention to environmental factors, may help manage your symptoms. If your discomfort persists or worsens, further evaluation by a cardiologist or pulmonologist may be warranted to rule out any additional underlying conditions.

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