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What Else Can Be Causing My Ever Increasing SOB?
Question: I have had Moderately low DLCO for 5-6 years. Started at 56% then gradually down to 48%. All the rest of my Spirometry has been normal at each test.
Have had clear High resolution Lung CTs several times. CT for Blood clots clear. All Echcardiograms both with and without stress normal. Had a right Heart XXXXXXX 5 years ago was normal, yet my shortness of breath has steadily been getting worse. Just doing normal everyday tasks now quite difficult. Can’t bend down to put on socks or cut toe nails etc Have to stop several time walking up a moderate slope to my house. Get exhausted and fatigued easily and have to lie down often thru the day.
Recently saw another Cardiologist who immediately diagnosed me with HFpEF but I only had some odema up my shin bones. So have been on varying doses of Frusimide to dry me out. Had been on BiCor but same stopped. Plain Echo and Stress Echo done and stress Echo clear. Now on Verapamil 240 mgs which is causing more SOB but my Cardiologist denies the Verapamil is doing this but said it’s my DLCO!! I will have yet another PFT to check but my Cardiologist Denys I have Pulmonary Hypertension as Echo’s and Stress Echo’s don’t show anything. Thinks it’s my lungs although he knows My HR Lung CT’s have only ever been normal!’ Had a 6 min walk test probably 2 years ago which they stopped after 3 mins!
What else can be causing my ever increasing SOB!
Have had clear High resolution Lung CTs several times. CT for Blood clots clear. All Echcardiograms both with and without stress normal. Had a right Heart XXXXXXX 5 years ago was normal, yet my shortness of breath has steadily been getting worse. Just doing normal everyday tasks now quite difficult. Can’t bend down to put on socks or cut toe nails etc Have to stop several time walking up a moderate slope to my house. Get exhausted and fatigued easily and have to lie down often thru the day.
Recently saw another Cardiologist who immediately diagnosed me with HFpEF but I only had some odema up my shin bones. So have been on varying doses of Frusimide to dry me out. Had been on BiCor but same stopped. Plain Echo and Stress Echo done and stress Echo clear. Now on Verapamil 240 mgs which is causing more SOB but my Cardiologist denies the Verapamil is doing this but said it’s my DLCO!! I will have yet another PFT to check but my Cardiologist Denys I have Pulmonary Hypertension as Echo’s and Stress Echo’s don’t show anything. Thinks it’s my lungs although he knows My HR Lung CT’s have only ever been normal!’ Had a 6 min walk test probably 2 years ago which they stopped after 3 mins!
What else can be causing my ever increasing SOB!
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello,
I passed carefully through your medical history and would like to explain that it is necessary to investigate for a possible implication of heart failure.
NT- proBNP test would be helpful to confirm heart failure; other issues that may have an impact are overweight (obesity); anemia.
Coming to the point where cardiac ultrasounds haven"t detected any abnormalities; it is recommended to undergo cardiac magnetic resonance imagine test; it would help to explore potential structural cardiac abnormalities (not detected on already performed tests); as well as exactly quantify cardiac function, cardiac tissue (myocardial) alterations due to potential systemic pathological conditions.
Pericardial constriction physiology can be revealed too. This would clarify also the questionable issue of pulmonary hypertension.
Once, cardiac issues have been clarified, potential pulmonary disorders should be investigated.
A decreased DLCO may be related to a decreased alveolar-capillary surface area like in emphysema; or due to thickening of the alveolar-capillary membrane like in interstitial lung disorders.
In addition, pulmonary vascular diseases like pulmonary embolism or pulmonary hypertension due to several systemic disorders may reduce the amount of red blood cells volume that come in contact with alveolar-capillary area leading to decrease blood gas exchange and shortness of breath.
Pulmonary function tests and pulmonary angio CT would help to differentiate the above mentioned disorders.
You should discuss with your attending doctor on the above mentioned issues.
Hope to have been helpful to you!
Let me know in case of any further questions.
Kind regards,
Dr. Ilir Sharka
cardiologist
I would explain as follows:
Detailed Answer:
Hello,
I passed carefully through your medical history and would like to explain that it is necessary to investigate for a possible implication of heart failure.
NT- proBNP test would be helpful to confirm heart failure; other issues that may have an impact are overweight (obesity); anemia.
Coming to the point where cardiac ultrasounds haven"t detected any abnormalities; it is recommended to undergo cardiac magnetic resonance imagine test; it would help to explore potential structural cardiac abnormalities (not detected on already performed tests); as well as exactly quantify cardiac function, cardiac tissue (myocardial) alterations due to potential systemic pathological conditions.
Pericardial constriction physiology can be revealed too. This would clarify also the questionable issue of pulmonary hypertension.
Once, cardiac issues have been clarified, potential pulmonary disorders should be investigated.
A decreased DLCO may be related to a decreased alveolar-capillary surface area like in emphysema; or due to thickening of the alveolar-capillary membrane like in interstitial lung disorders.
In addition, pulmonary vascular diseases like pulmonary embolism or pulmonary hypertension due to several systemic disorders may reduce the amount of red blood cells volume that come in contact with alveolar-capillary area leading to decrease blood gas exchange and shortness of breath.
Pulmonary function tests and pulmonary angio CT would help to differentiate the above mentioned disorders.
You should discuss with your attending doctor on the above mentioned issues.
Hope to have been helpful to you!
Let me know in case of any further questions.
Kind regards,
Dr. Ilir Sharka
cardiologist
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your helpful answer. I had an NT - proBNP Test a year or two ago and it was normal then.
I’ve been on antidepressants for about 3 years and that has upped my weight a lot so yes I’m overweight but exercising is very difficult due to the SOB but I do walk with a Walker probably at least 4 times a week. I’ve weaned myself off the Antidepressant so hoping to lose weight. Drs wouldn’t discharge me from hospital as without a Walker as I’d had numerous falls which no one can find the reason for, but I’d been very sick with Acute recurrent Pancreatitis for some time and then got a bowel perforation after anERCP and Sphincterotomies on both ducts.
Haven’t heard of Cardiac Magnetic Imaging Test . Is that the same as CT Coronary angiogram?I had that after being in hospital with chest pain 5-6 years ago and it was clear.
Ok I’ll show this to my Cardiologist but he once he’s made up his mind he seems to be not open to any other possibility.
Thank you!
XXXXXXX Puddlr
I’ve been on antidepressants for about 3 years and that has upped my weight a lot so yes I’m overweight but exercising is very difficult due to the SOB but I do walk with a Walker probably at least 4 times a week. I’ve weaned myself off the Antidepressant so hoping to lose weight. Drs wouldn’t discharge me from hospital as without a Walker as I’d had numerous falls which no one can find the reason for, but I’d been very sick with Acute recurrent Pancreatitis for some time and then got a bowel perforation after anERCP and Sphincterotomies on both ducts.
Haven’t heard of Cardiac Magnetic Imaging Test . Is that the same as CT Coronary angiogram?I had that after being in hospital with chest pain 5-6 years ago and it was clear.
Ok I’ll show this to my Cardiologist but he once he’s made up his mind he seems to be not open to any other possibility.
Thank you!
XXXXXXX Puddlr
Brief Answer:
Opinion as follows:
Detailed Answer:
Hello again!
Thank you for the additional medical information!
Let me explain that cardiac magnetic resonance test could help in the assessment of a possible cause of heart failure if present.
Considering your clinical conditions, may be also physical de-conditioning plays a role.
Anyways, another important factor to consider would be the impact of recurrent acute pancreatitis on pulmonary function.
It is actually well known that the inflammatory state of pancreatitis with the increased level of cytokines (like TNF-α, IL-6, etc.) and chemokines (like IL-8) may lead to pulmonary interstitial tissue infiltration by neutrophils with subsequent pulmonary parenchyma injury and acute respiratory distress syndrome.
This may be an important cause of your clinical symptomatology (shortness of breath). Laboratory tests of several cytokines, etc. could be helpful.
Coming to this point, it is important to discuss with your attending doctor about all the potential factors during the differential diagnosis.
Wishing you good health!
Regards,
Dr. Iliri
Opinion as follows:
Detailed Answer:
Hello again!
Thank you for the additional medical information!
Let me explain that cardiac magnetic resonance test could help in the assessment of a possible cause of heart failure if present.
Considering your clinical conditions, may be also physical de-conditioning plays a role.
Anyways, another important factor to consider would be the impact of recurrent acute pancreatitis on pulmonary function.
It is actually well known that the inflammatory state of pancreatitis with the increased level of cytokines (like TNF-α, IL-6, etc.) and chemokines (like IL-8) may lead to pulmonary interstitial tissue infiltration by neutrophils with subsequent pulmonary parenchyma injury and acute respiratory distress syndrome.
This may be an important cause of your clinical symptomatology (shortness of breath). Laboratory tests of several cytokines, etc. could be helpful.
Coming to this point, it is important to discuss with your attending doctor about all the potential factors during the differential diagnosis.
Wishing you good health!
Regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thankyou again. One other thing I hadn ‘t mentioned was that I also developed Ascending Cholangitis and I had the bile duct stented over some months with up to 3 stents which finally resulted in Bacteremia, so the stents were removed and I was without stents for another year with my Liver Function tests getting steadily worse. I then had a Heptachojejunnostomy to by pass the Bile Duct in May 2020 and since then I have not had anymore pancreatitis or Cholangitis. The cause of the Pancreatitis was because both my Pancreatic and Bile duct went into a Diverticulum in my Duodenum.
I take regular Creon and have also developed Diabetes 2 diet controlled at present.
Had my gallblader out in Nov 2017.
So it’s a great relief being Pancreatitis free.
Still my shortness of breath continues to get worse.
I take regular Creon and have also developed Diabetes 2 diet controlled at present.
Had my gallblader out in Nov 2017.
So it’s a great relief being Pancreatitis free.
Still my shortness of breath continues to get worse.
Brief Answer:
Differential diagnosis required:
Detailed Answer:
Hello again,
Pulmonary function tests would be helpful to investigate residual pulmonary dysfunction (obstructive/restrictive physiology) and guide differential diagnosis workup.
Several potential factors may have influenced shortness of breath development considering your medical history. They need to be checked consecutively as we mentioned previously in our discussion.
Let me know in case of any further issue of concern.
Greetings,
Dr. Iliri
Differential diagnosis required:
Detailed Answer:
Hello again,
Pulmonary function tests would be helpful to investigate residual pulmonary dysfunction (obstructive/restrictive physiology) and guide differential diagnosis workup.
Several potential factors may have influenced shortness of breath development considering your medical history. They need to be checked consecutively as we mentioned previously in our discussion.
Let me know in case of any further issue of concern.
Greetings,
Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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