Unexplained Rapid Heartbeat and Shortness of Breath

Q: Unexplained Rapid Heartbeat and Shortness of Breath

Hello Nicole： Your mother's condition is not considered complex, but it is important to have regular health check-ups for the following reasons： 1. <br>Patients with hypertension are advised to check their lipid levels and kidney function annually. <br>2. <br>Hepatitis B carriers

Frequent unexplained palpitations leading to shortness of breath?

Hello Dr.
Tsai,
I would like to ask a few questions regarding my mother (56 years old).
Recently, she has been experiencing unexplained episodes of rapid heartbeat.
She reports that her heart races and she feels short of breath, which leads to a cough.
However, after coughing briefly, her breathing becomes much easier.
These symptoms mostly occur during meals, especially after eating.
My mother has a history of thyroid disease, is a carrier of hepatitis B, and has hypertension.
I would like to know if her symptoms indicate any specific illness, such as a pneumothorax.
Which specialty should she consult, and what kind of examinations should be performed?
Additionally, my mother has had poor health since her youth and has been on medication, but she is prone to drug allergies, particularly experiencing edema (swelling to the point where she cannot see clearly and her legs swell significantly).
As a result, she often discontinues medications due to discomfort, leading to incomplete treatment of her conditions.
She also takes dietary supplements for bone stiffness and pain, such as glucosamine, which also causes edema.
Could her severe edema indicate a kidney issue? What specialty should she see for follow-up, and what should we pay attention to in her daily life?
I have many questions, and I would greatly appreciate your guidance!
Wishing you peace and happiness.

Nicole, 20~29 year old female. Ask Date: 2006/05/27

Dr. Cai Jueren reply Family Medicine

Hello Nicole: Your mother's condition is not considered complex, but it is important to have regular health check-ups for the following reasons: 1.
Patients with hypertension are advised to check their lipid levels and kidney function annually.
2.
Hepatitis B carriers are recommended to have liver function tests and abdominal ultrasounds every six months to one year.
3.
Thyroid patients, regardless of whether they are on medication, should have their thyroid hormones (TSH, free T4) checked annually.
4.
Individuals over the age of 50 should have their bone mineral density checked annually, especially women.
I would like to remind you that regardless of any medications or health supplements, please consult your family physician before taking them.
Additionally, since your mother may have a history of allergies, she should be particularly cautious when taking medications.
Thank you for your letter.

Reply Date: 2006/05/27

More Info

Hello! Thank you for reaching out with your concerns regarding your mother's health. Based on the symptoms you've described, it sounds like she is experiencing episodes of rapid heartbeat (tachycardia) and shortness of breath, particularly after meals. Given her medical history, including thyroid issues, hepatitis B carrier status, and hypertension, there are several factors to consider.

Understanding the Symptoms
1. Rapid Heartbeat and Shortness of Breath: These symptoms can arise from various conditions. In your mother's case, they may be related to her thyroid condition, especially if she has hyperthyroidism, which can cause increased heart rate and anxiety. Additionally, the act of eating can stimulate the vagus nerve, which may lead to changes in heart rate and breathing patterns, particularly in individuals with underlying conditions.

2. Coughing and Relief: The fact that coughing provides some relief from her shortness of breath could indicate that there is some form of airway obstruction or irritation. This could be due to gastroesophageal reflux disease (GERD), which is common in individuals with a history of thyroid issues and can cause symptoms like coughing and difficulty breathing after meals.

3. Fluid Retention and Swelling: The swelling (edema) you mentioned, especially around the eyes and legs, can indeed be a sign of kidney issues, but it can also be related to heart problems or side effects of medications. Given her history of hypertension, it’s crucial to monitor her blood pressure and kidney function.

Potential Conditions
- Thyroid Dysfunction: Given her history of thyroid disease, it’s essential to evaluate her thyroid hormone levels. Hyperthyroidism can lead to symptoms like rapid heartbeat and anxiety.

- Heart Issues: Conditions such as heart failure or arrhythmias could also cause similar symptoms. Given her hypertension, it’s important to rule out any cardiac issues.

- Gastroesophageal Reflux Disease (GERD): This can cause respiratory symptoms and may be exacerbated by eating, leading to coughing and shortness of breath.

- Kidney Problems: The edema could suggest kidney dysfunction, which should be evaluated through blood tests (like creatinine and electrolytes) and possibly a urinalysis.

Recommended Actions
1. Consult a Cardiologist: Given her symptoms of rapid heartbeat and shortness of breath, it would be prudent to consult a cardiologist. They may recommend an electrocardiogram (ECG), echocardiogram, or stress test to evaluate her heart function.

2. Endocrinologist Consultation: Since she has a history of thyroid disease, seeing an endocrinologist would be beneficial to assess her thyroid function and manage any abnormalities.

3. Pulmonologist Visit: If respiratory symptoms persist, a pulmonologist may be needed to evaluate her lung function and rule out any respiratory conditions.

4. Regular Monitoring: Keep track of her blood pressure, heart rate, and any episodes of swelling or discomfort. This information will be helpful for her healthcare providers.

5. Medication Review: Since she has a history of medication allergies and side effects, it’s crucial to have a healthcare provider review her current medications and consider alternatives if necessary.

Lifestyle Considerations
- Dietary Adjustments: Encourage her to eat smaller, more frequent meals to avoid overwhelming her system. Monitoring salt intake can also help manage fluid retention.

- Hydration: Ensure she stays hydrated but consult with her doctor about the appropriate amount of fluid intake, especially if kidney function is a concern.

- Stress Management: Since stress can exacerbate symptoms, consider relaxation techniques such as deep breathing exercises, yoga, or meditation.

In summary, your mother’s symptoms warrant a thorough evaluation by a healthcare professional, considering her complex medical history. It’s essential to approach her care holistically, addressing both her physical symptoms and any potential underlying conditions. Please ensure she receives the necessary follow-up care and support. Wishing you both the best of health!

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I recommend that you discuss the above situation further with your attending physician. Wishing you good health. Thank you!