Which Specialist to See for Unexplained Breathing and Dizziness Issues?

Q: Which Specialist to See for Unexplained Breathing and Dizziness Issues?

Hello： Your discomfort may be due to vasovagal syncope or situational syncope. <br>It is usually advisable to avoid triggering situations, such as the ones you mentioned： excessive heat, stuffiness, rainy days, poorly ventilated indoor spaces, and crowded places. <br>Anemia can a

I'm not sure which specialty to see?

Hello Doctor, I have had the following symptoms since childhood: whenever it is too hot, stuffy, rainy, or in poorly ventilated indoor spaces with large crowds, I easily experience sudden shortness of breath, dizziness, and when mild, I tend to yawn frequently, have difficulty concentrating, and feel nauseous.
In severe cases, I occasionally vomit, my face turns pale, I break out in cold sweats, and I feel the urge to have a bowel movement.
Sometimes, I have to squat on the ground for over 30 minutes before I feel better, and I can hardly sit down.
The frequency and severity of these symptoms have increased from once or twice a year to several dozen times in the past year.
Two years ago, I visited a major hospital and was diagnosed with Mediterranean anemia and iron deficiency anemia.
I initially thought these symptoms were caused by anemia, but after continuing medication, my blood tests have returned to normal at each follow-up appointment, and my annual health check results are also normal.
I also considered the possibility of cardiac hypoxia and had an echocardiogram done, which showed normal results.
I cannot determine the cause, and I am unsure which specialty to consult for improvement.
My mother has similar symptoms, but her episodes occur very infrequently, almost once every few years.
I am worried that since I do not experience symptoms during consultations, no cause can be identified despite numerous tests.
Now, I experience episodes at least 3-5 times a month, which severely affects my work.
I would like to ask which specialty I should consult to find the underlying cause and receive treatment.
Thank you.

Belle, 30~39 year old female. Ask Date: 2022/11/22

Dr. Lin Zhebin reply Family Medicine

Hello: Your discomfort may be due to vasovagal syncope or situational syncope.
It is usually advisable to avoid triggering situations, such as the ones you mentioned: excessive heat, stuffiness, rainy days, poorly ventilated indoor spaces, and crowded places.
Anemia can also present similar symptoms, but you have already received relevant treatment.
Additionally, it is important to consider the possibility of an acute arrhythmia; however, as you mentioned, there may not be any issues detected during examinations when you are not experiencing symptoms.
Therefore, I would recommend that you visit a cardiologist for a 24-hour Holter monitor to see if any arrhythmias can be detected during episodes.
In summary, I suggest that you consult a neurologist to check for any issues related to cranial nerves and associated blood vessels.
Additionally, I recommend seeing a cardiologist to evaluate for cardiovascular issues and arrhythmias.
If all tests return normal, then considering a consultation with a psychosomatic medicine specialist may be appropriate.

Reply Date: 2022/11/22

More Info

Based on your description, it sounds like you are experiencing a complex set of symptoms that could be related to several underlying conditions. Given the nature of your symptoms—shortness of breath, dizziness, and gastrointestinal discomfort—it's essential to approach this systematically.

Recommended Specialists
1. Pulmonologist (Lung Specialist): Since you are experiencing significant breathing difficulties, a pulmonologist would be a good starting point. They can conduct tests such as pulmonary function tests, imaging studies like chest X-rays or CT scans, and possibly a bronchoscopy to evaluate your lung function and rule out any respiratory conditions.

2. Cardiologist (Heart Specialist): Although you mentioned that previous cardiac evaluations have been normal, it may be worth revisiting a cardiologist, especially given your symptoms of dizziness and faintness. They can perform additional tests, such as an echocardiogram or a stress test, to ensure that there are no underlying heart issues contributing to your symptoms.

3. Hematologist (Blood Specialist): Since you have a history of anemia, particularly Mediterranean anemia and iron deficiency anemia, consulting a hematologist could be beneficial. They can assess your blood parameters and ensure that your anemia is adequately managed, as anemia can contribute to fatigue, dizziness, and shortness of breath.

4. Gastroenterologist (Digestive System Specialist): Given your symptoms of nausea and gastrointestinal discomfort, a gastroenterologist may help rule out any digestive issues, such as gastroesophageal reflux disease (GERD) or other gastrointestinal disorders that could be contributing to your symptoms.

5. Psychiatrist or Psychologist: Since you mentioned that your symptoms can be triggered by stress or anxiety, it might be helpful to consult a mental health professional. They can help determine if anxiety or panic attacks are contributing to your physical symptoms and provide strategies for managing these feelings.

Additional Considerations
- Environmental Factors: You noted that your symptoms worsen in hot, humid, or crowded environments. This could indicate a sensitivity to environmental triggers, which may be exacerbating your anxiety or respiratory issues. Keeping a symptom diary to track when and where these episodes occur could provide valuable information for your healthcare providers.

- Lifestyle Modifications: Consider lifestyle changes that may help alleviate your symptoms. Staying hydrated, avoiding known triggers (like extreme heat or crowded places), and practicing relaxation techniques such as deep breathing or mindfulness could be beneficial.

- Follow-Up Testing: Since your symptoms have increased in frequency and severity, it may be worthwhile to discuss with your healthcare provider the possibility of continuous monitoring or additional tests that can capture your symptoms when they occur.

Conclusion
In summary, a multidisciplinary approach may be necessary to address your complex symptoms. Start with a pulmonologist and a cardiologist, and consider consulting a hematologist and a mental health professional. Documenting your symptoms and their triggers will be crucial in helping your healthcare providers understand your condition better. Don't hesitate to advocate for yourself and seek further evaluations if your symptoms persist or worsen. Your health and well-being are paramount, and finding the right specialists can lead to a more accurate diagnosis and effective treatment plan.

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