Chest Tightness and Breathing Issues: Propranolol Insights

Chest tightness and difficulty in taking a deep breath, propranolol?

Hello, Doctor.
I was diagnosed with COVID-19 in May this year, and I have a habit of smoking.
Recently, I've been experiencing slight chest tightness and difficulty breathing, which I can alleviate somewhat by yawning or taking deep breaths.
Sometimes, even deep breathing feels constricted, and I find it hard to describe.
Initially, these symptoms occurred a few times a week, but this week they have become daily occurrences.
Therefore, I visited a pulmonologist two days ago.
The doctor performed an electrocardiogram (ECG) and a chest X-ray, but found no issues and prescribed Xanax, suggesting I could take it if needed.
I was advised to see a cardiologist the next day.
The cardiologist reviewed the previous day's ECG and chest X-ray, listened with a stethoscope, and also found no significant problems.
He prescribed propranolol 10 mg, instructing me to take one tablet every night, and said I could stop if I noticed improvement.
After taking propranolol last night, I felt a noticeable difference shortly after; deep breathing no longer felt constricted, and I could take full breaths.
However, my body still has an urge to take deep breaths, as if normal breathing isn't satisfying enough.
This morning, I still feel some improvement, but it's not complete.
The outpatient doctor did not inform me of any specific issues that might be causing these symptoms.
I would like to ask if you could help me speculate on what might be wrong with me.
Thank you!

Xu, 20~29 year old female. Ask Date: 2022/12/01

Dr. He Dongjin reply Cardiology

Hello, the effectiveness of the medication may be due to a slight imbalance in the autonomic nervous system.
It would be advisable to quit smoking, as it should lead to further improvement.
Changhua Hospital cares about your well-being.

Reply Date: 2022/12/01

More Info

Understanding chest tightness and breathing difficulties can be quite complex, especially when considering the interplay of various physiological and psychological factors. Based on your description, it seems that you have been experiencing symptoms such as chest tightness and difficulty breathing, which have become more frequent and pronounced over time. You have also mentioned a history of smoking, which can significantly impact lung function and overall cardiovascular health.

The initial evaluations you underwent, including an electrocardiogram (ECG) and chest X-ray, did not reveal any significant abnormalities. This is a positive sign, as it suggests that there may not be any acute or severe cardiac or pulmonary issues at play. However, the symptoms you describe—such as the need to take deep breaths, feelings of tightness in the chest, and the sensation of not being able to breathe fully—can often be linked to anxiety or stress, especially if they have escalated in frequency and intensity.

Propranolol, a non-selective beta-blocker, is often prescribed for various conditions, including anxiety, hypertension, and certain types of heart rhythm disorders. It works by blocking the effects of adrenaline on the body, which can help reduce heart rate and alleviate some symptoms of anxiety. In your case, it appears that taking propranolol has provided some relief from the sensation of breathlessness, which might indicate that your symptoms could be partially related to anxiety or a heightened state of arousal in your autonomic nervous system.

It's important to note that while propranolol can help manage symptoms, it does not address the underlying causes of your discomfort. The fact that you still feel the need to take deep breaths suggests that there may be a psychological component to your symptoms. This is not uncommon, as anxiety can manifest physically in various ways, including hyperventilation or the sensation of tightness in the chest.

Additionally, your smoking history is a significant factor that could contribute to respiratory issues. Smoking can lead to chronic obstructive pulmonary disease (COPD), emphysema, and other lung conditions that can cause symptoms similar to what you are experiencing. Quitting smoking is one of the most effective ways to improve lung health and reduce the risk of further complications.

Given your symptoms and the lack of clear findings from your medical evaluations, it may be beneficial to explore further diagnostic options. A pulmonary function test could provide more insight into your lung capacity and function, while a referral to a mental health professional could help address any anxiety-related components of your symptoms.

In summary, while propranolol seems to have provided some relief, it is essential to consider a comprehensive approach to your health. This includes addressing any potential psychological factors, quitting smoking, and possibly undergoing further testing to rule out any underlying respiratory conditions. If your symptoms persist or worsen, it is crucial to follow up with your healthcare provider for additional evaluation and management.

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