Fatigue and Breathing Issues: When to Seek Heart Care

Experiencing fatigue and occasional shortness of breath?

Hello, doctor.
Over a year ago, I experienced a period of shortness of breath.
Although I was breathing, I felt like I wasn't getting enough air.
I later thought it might be due to drinking too much coffee (I was consuming about three cups a day for work).
After that, it improved, and I didn't experience it again, but occasionally it still happens, though infrequently and not easily noticeable.
Recently, I've started feeling unwell again; sometimes I suddenly have difficulty breathing and often find myself needing to take deep breaths involuntarily.
Climbing stairs feels very strenuous when I feel uncomfortable, and I've measured my heart rate during these times, which is around 100 beats per minute (normally it's between 60-80).

I used to have a habit of playing basketball on weekends until February of this year, where I could play for three hours.
However, after one session of drawing on the computer, I felt something was off.
I measured my heart rate while lying down, and it was around 100 beats per minute, which felt very uncomfortable and caused a sense of fear and anxiety.
This lasted for about one to two minutes.
I’m not sure if this was palpitations, as it wasn't a pronounced pounding but rather a simple increase of about 40 beats compared to usual.
Concerned about potential heart issues, I became hesitant to engage in vigorous exercise.

As an engineer, I spend at least 12 hours a day in front of a computer, and I don't want my health to deteriorate.
Occasionally, I go for a 20-minute jog, but now I experience a slight tightness in my throat and back during exercise.
I'm unsure if this is related to my heart or the muscles in my neck and back.
I visited two hospitals (Christian and Chang Gung) for heart evaluations, including two 24-hour Holter monitors, and the doctors said everything was fine.
I also had blood tests to check for thyroid issues, which were negative.

In the past week or two, while jogging, I initially felt energetic, but then suddenly experienced an unusual sensation, as if I couldn't get enough air, leading to a fear of potential problems if I continued running.
Consequently, I stopped running.
The day after exercising, I feel particularly unwell.
While sitting, my heart rate is 60-70, but when I stand up, it increases to 80-100, and it remains elevated while standing without decreasing even after a long time.
Is this a sign that my heart is getting worse, or is it simply fatigue?
Before January of this year, my exercise intensity was still high, but now even light jogging or moderate exercise makes me feel extremely fatigued, and standing becomes difficult.
It feels like just yesterday I was healthy and active, but today everything feels wrong.
Is this a heart issue? If I need to see a cardiologist, what kind of tests should I undergo? Additionally, I have always had a resting heart rate around 65 beats per minute, so when my heart rate approaches 90, I can clearly feel discomfort—not as a pounding sensation, but rather a feeling of tension and something being off.
I hope you can help me.
Thank you.

Gongchengshi, 20~29 year old female. Ask Date: 2006/04/26

Dr. He Dongjin reply Cardiology

Dear Sir,
Most of your described symptoms are caused by autonomic nervous system dysfunction.
Another part, such as the deterioration of cardiopulmonary function and the sensation of chest tightness, should first rule out angina.
I would like to know if you smoke.
If your cardiac examination, including exercise electrocardiogram or echocardiogram, shows no abnormalities, you should take some medications to adjust your heart rhythm and gradually start exercising, which should help improve your condition.
Changhua Hospital cares about you.

Reply Date: 2006/04/26

More Info

When it comes to understanding fatigue and breathing issues, especially in the context of potential heart problems, it’s essential to approach the situation with a comprehensive perspective. Your symptoms of feeling short of breath, experiencing rapid heart rates, and having a sense of anxiety or fear during physical activity can be concerning and warrant further investigation.

Firstly, it’s important to recognize that shortness of breath (dyspnea) can arise from various causes, including respiratory issues, cardiovascular problems, anxiety, or even lifestyle factors such as caffeine consumption. In your case, you mentioned that your symptoms improved after reducing your coffee intake, which suggests that stimulants can exacerbate feelings of anxiety and lead to physiological responses such as increased heart rate and shallow breathing.

Your experience of feeling like you cannot get enough air, especially during physical exertion, could indicate a few possibilities. Given your history of being active and then experiencing a decline in your exercise tolerance, it’s crucial to consider both cardiac and non-cardiac factors. While you have undergone tests such as 24-hour Holter monitoring and blood tests that returned normal results, it is still possible that there are underlying issues that need to be explored further.

From a cardiovascular perspective, symptoms like increased heart rate (tachycardia) during exertion, especially if it reaches around 100 beats per minute when you are typically in the 60-80 range, can be indicative of several conditions. These might include exercise-induced asthma, anxiety-related hyperventilation, or even early signs of cardiac issues, particularly if there is a family history of heart disease or other risk factors present.

Given your symptoms, it would be prudent to consult a cardiologist for a thorough evaluation. You may want to discuss the following tests with your healthcare provider:
1. Echocardiogram: This ultrasound of the heart can assess the structure and function of your heart, including the heart valves and chambers.

2. Stress Test: This test can help evaluate how your heart performs under physical stress, which may reveal issues that are not apparent at rest.

3. Pulmonary Function Tests: Since you have experienced shortness of breath, these tests can help determine if there are any underlying lung issues contributing to your symptoms.

4. Blood Tests: While you have had some blood tests, it may be beneficial to check for markers of inflammation or other conditions that could affect your heart and lungs.

5. Anxiety Assessment: Given the interplay between anxiety and physical symptoms, it might be helpful to speak with a mental health professional. Cognitive-behavioral therapy (CBT) or other forms of therapy can be effective in managing anxiety, which may in turn alleviate some of your physical symptoms.

In addition to these evaluations, lifestyle modifications can also play a significant role in managing your symptoms. Regular, moderate exercise can improve cardiovascular health and reduce anxiety, but it’s essential to listen to your body and not push yourself too hard, especially if you are feeling fatigued. Incorporating relaxation techniques such as deep breathing exercises, mindfulness, or yoga can also help manage anxiety and improve your overall sense of well-being.

In summary, while your previous tests have not indicated significant heart issues, your ongoing symptoms warrant further investigation. A comprehensive approach that includes both physical and mental health assessments will provide a clearer picture and help guide you towards effective management strategies. Don’t hesitate to seek the care you need, as early intervention can often lead to better outcomes.

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