Chest Symptoms: Coughing, Wheezing, and Heart Palpitations - Pulmonology

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Wheezing, crepitations, sputum production?


Dear Vice President Wang,
I have been experiencing the symptoms described for nine years, but they have recently worsened over the past month.
The symptoms occur with any physical activity, such as climbing stairs, brisk walking, or during emotional stress.
They can also happen every morning upon waking, often accompanied by a few coughs.
The symptoms occur sequentially and can coexist:
1.
Mild shortness of breath
2.
Coughing (which can be either mild or severe)
3.
Possibly a small amount of clear phlegm (coughing it out provides significant relief; if not, it becomes more uncomfortable)
4.
Followed by palpitations or a tightening sensation in the chest (around the xiphoid process or three fingers above)
5.
Dry heaving (if dry heaving does not occur, the previous symptoms will persist; however, after a few episodes of dry heaving, all symptoms will quickly lessen or disappear)
I have had a stent for over nine years and only began experiencing these issues four months after starting related medications.
Initially, the symptoms would only occur when lifting heavy objects up the stairs.
I have undergone two myocardial perfusion scans, three echocardiograms, and a 24-hour Holter monitor.
The ECG showed premature ventricular contractions in the left ventricle, but the physician indicated that it was still within a safe range and unrelated to the cardiology medications.
Five years ago, I had a thoracic examination, including X-rays and spirometry, which showed no abnormalities.
I was referred to gastroenterology for an uncomfortable endoscopy, which revealed no issues in the esophagus or gastroesophageal junction.
However, it was noted that even in the absence of abnormalities, experiencing nausea and a sensation of food residue in the throat could indicate gastroesophageal reflux, which might also cause palpitations.
Recently, I noticed an interesting phenomenon: if I suck on a mint before anticipating the onset of the above symptoms, they may not occur at all, or if they do, they are very mild and resolve quickly.

I am truly puzzled about the root cause of these issues—whether they stem from cardiac problems, reflux issues, or emotional factors.
I would greatly appreciate your insights on this matter.
Thank you.

Mr. Zhang, 50~59 year old female. Ask Date: 2022/09/22

Dr. Wang Lanfeng reply Pulmonology


Hello: Based on your description, you already have issues with coronary artery obstruction, along with gastroesophageal reflux disease.
Therefore, the symptoms you mentioned could potentially arise from these conditions.
To determine which specific disease is causing your symptoms, it would be more accurate for your attending physician to assess all clinical data.
Additionally, I would like to know if you have a long-term smoking habit.
The symptoms could also be due to chronic obstructive pulmonary disease caused by prolonged smoking.
I recommend discussing your condition in detail with your attending physician before making a diagnosis.
Thank you.

Reply Date: 2022/09/22

More Info


Based on the symptoms you've described, it appears that you are experiencing a complex interplay of respiratory and cardiovascular issues, which can be quite distressing. Your symptoms of shortness of breath, coughing, heart palpitations, and the sensation of tightness in the chest can be indicative of several underlying conditions. Given your history of having a stent placed and ongoing medication, it is essential to approach this situation with a comprehensive understanding.


Potential Causes of Your Symptoms
1. Cardiovascular Issues:
- Ischemic Heart Disease: Given your history of having a stent, there is a possibility that you may be experiencing angina or other ischemic symptoms, especially if you notice these symptoms during exertion or emotional stress.

- Arrhythmias: The left ventricular premature contractions (PVCs) noted in your 24-hour ECG could contribute to the sensation of palpitations and may be exacerbated by stress or physical activity. While PVCs are often benign, they can sometimes lead to more significant symptoms if they occur frequently.

- Heart Failure: Symptoms like shortness of breath and fatigue can also indicate heart failure, particularly if your heart's pumping ability is compromised.

2. Respiratory Issues:
- Chronic Obstructive Pulmonary Disease (COPD) or Asthma: If you have a history of respiratory issues, these conditions could explain your wheezing and cough, particularly if they worsen with exertion.

- Gastroesophageal Reflux Disease (GERD): Your mention of a sensation of food residue in the throat and the possibility of esophageal reflux could be causing irritation that leads to coughing and heart palpitations.

3. Anxiety and Stress:
- Anxiety can manifest physically, leading to symptoms such as palpitations, shortness of breath, and even gastrointestinal discomfort. The fact that you find relief with peppermint suggests that there may be a psychosomatic component to your symptoms.


Diagnostic Approach
Since you have already undergone several tests, including myocardial perfusion scans, echocardiograms, and 24-hour ECG monitoring, it may be beneficial to consider the following:
- Pulmonary Function Tests: To assess for any underlying respiratory conditions that may not have been fully evaluated.

- Esophageal pH Monitoring: If GERD is suspected, this test can help determine if acid reflux is contributing to your symptoms.

- Holter Monitor: A longer-term ECG monitoring could provide more insight into the frequency and nature of your PVCs and any correlation with your symptoms.


Management Strategies
1. Medication Review: Ensure that your current medications are optimized for both your cardiovascular and respiratory health. Discuss with your physician the potential need for adjustments based on your symptoms.

2. Lifestyle Modifications:
- Diet: If GERD is a concern, consider dietary changes to minimize reflux, such as avoiding spicy foods, caffeine, and large meals before bedtime.

- Exercise: Engage in regular, moderate exercise as tolerated, which can improve cardiovascular health and reduce anxiety.

- Stress Management: Techniques such as mindfulness, yoga, or therapy can help manage anxiety, which may alleviate some of your symptoms.

3. Follow-Up Care: Regular follow-ups with your cardiologist and possibly a pulmonologist or gastroenterologist may be necessary to monitor your condition and adjust treatment as needed.


Conclusion
Your symptoms are multifaceted and may stem from a combination of cardiovascular, respiratory, and psychological factors. It is crucial to maintain open communication with your healthcare providers to ensure a thorough evaluation and tailored management plan. Given the complexity of your situation, a multidisciplinary approach may be beneficial in addressing all aspects of your health.

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