Question: Hi, Doctor. I am in the process of being evaluated because of shortness of breath and high heart rate, which I am having only on exertion. It is directly proportional to my level of exertion (for instance, dressing has less severe symptoms than showering). It has been happening for 4 weeks now and it is with practically any exertion. With relatively significant exertion, it can be pretty bad. My heart rate and breathing recover quickly as soon as I stop the activity. It does not at all feel like anxiety. I cannot even fathom it being related to anxiety. I am not anxious or fearful at all. When I get short of breath, it does not scare me at all. I don't feel like I'm dying. I don't even feel my heart racing (I only know my heart rate because I'm a nurse and take it with a pulse oximeter when I'm short of breath in order to share with the doctor). I just feel like I have been exercising very hard when I have only been doing minimal activity. I feel like someone who is suddenly terribly out of shape. No anxiety or fearfulness whatsoever. None. Not even a little. I'm not overly sensitive to what is happening when I experience symptoms. It's just "normal" now and I know that it will resolve once I stop the activity. Most cardiac reasons have been ruled out with testing. I see a lung specialist next. I am wondering - is it possible to have shortness of breath and high heart rate (with exertion only) due to anxiety even without feeling any anxiousness or fearfulness at all? None. This feels 100% physical. But, I keep hearing "it could be anxiety." I do have anxiety related to phobias (tall buildings, etc) but no panic attacks or anything ever. Thank you.

Thank you, Doctor. This makes a lot of sense. However, I do not have the sensation of palpatations. So, while I can understand that the sensation of palpatations could cause the whole cascade of reactions to follow, as you described, what could be the catalyst for all of that when I don't have such a sensation? I can simply walk across the room, perform some very minimal activity, and get short of breath. It feels exactly like I am just really out of shape. I'm not thinking about it at all, I don't feel anything prior (like fear or palpatations), I just feel like I have performed a much more strenuous task than I actuallly did. Its also directly proportional to the level of exertion - walking across the room and doing something very minimal will cause minor shortness if breath, whereas something that requires more exertion will cause more shortness of breath. Just like I would feel if I were extremely unfit. Do you still think this could be caused by anxiety even with no perceived catalyst (such as the sensation of palpatations )? If it can be, I certainly want to know and understand that, so I thank you in advance for your input!