Chest Tightness

[valliali]

Through the course of my illness, I have found that I get these episodes of constant chest tightness, where I feel that I am only able to get a half breath and I become short of breath very easily, like even upon trying to complete a sentence. The weird thing is that these episodes come on suddenly and for no real apparent reason, last a couple of weeks, then just disappear and don't return for months.

I have found that for about the last week, my finger joints have been swelling up and are very stiff and curled in again, although this hasn't happened for over a year. It was a couple days ago that my chest became very, very tight.

I took an NSAID last night to help with the joint stiffness but found that it also seemed to help my chest tightness. It is no cure, but I felt like I could probably breathe 3/4 of the way instead.

Does anyone else have anything like this? This would point to some kind of inflammation. I was thinking COPD or asthma, but it seems strange that it comes in these random episodes and then won't return for like six or so months.

It's horribly uncomfortable. Like if I didn't know that it would go away in a couple of weeks, I really don't know that I could live with this constant sensation of on the verge suffocation. Though I know I am getting enough oxygen (pink mucous membranes), it feels like I am just slowly suffocating.

I know that I need to see a pulmonologist, but the tightness/SOB is so unpredictable and sporadic it's been hard to schedule a time that I am symptomatic. I have had to cancel two or three previous appts with one b/c my symptoms disappeared by the time I was able to get an appt. I have also gone to the ER for the chest tightness, where they did an XRay and EKG and told me I was fine.

[Mrs. Burschman]

I have gone through periods where my chest was really tight. In me, I think it was related to my sympathetic nervous system being in overdrive. Kind of like part of the "flight or fight" response. It felt like all the muscles were really tense. I didn't find anything in particular that helped besides getting my sympathetic nervous system calmed down.

I'm sorry you're dealing with this! It's really uncomfortable. I just wanted to let you know that it isn't necessarily anything serious. It didn't seem to be in my case, since I'm still alive and typing.

[mountain girl]

I have pots and would say the chest "heaviness" or tightness as you describe it is a very annoying and common symptom for me as well as feeling very uncomfortable. I get the chest tightness just from being up too long and find that sometimes laying down on my side helps or in a semi reclined position on my back against two pillows. I have also had it happen when I have been up and about at work and then come home to go to bed, so then it seems like the moving around to being still changes something. I also have Ativan 1 mg. that helps. Sometimes I need the Ativan every day and sometimes not at all. I don't know exactly what happens in the body to cause us this feeling, but I definitely experience it too.

[juliegee]

Hey Valiali,

I have the same symptom of chest tightness. I experienced it for years before I was DXed with MCAD. What helps me the most is singulair. I take it daily now. Back when my symptoms were like yours I would take it as needed and I got relief within 10-15 mins. Sometimes that alone doesn't do it and I use atrovent in a nebulizer.

You probably should get tested for asthma. I'm sure others here can tell you more (and better than I can) about that process. As I understand it, there are 2 types of tests: one that's good IF you are having symptoms and one where they provoke symptoms. I was lucky enough to be able to do the first when I was symptomatic. It demonstrated that I did have a problem, BUT I was unable to be rescued with albuterol (sp?), the treatment of choice for asthma. From that test, they determined I did not have asthma. Checking for asthma is probably a really good idea as it can progress to an emergency as can the chest tightness with MCAD.

This is probably dumb advice, but before I figured things out, I would just lie down & go to sleep. It hurt so much and was so uncomfortable, I didn't have much of a choice. I usually felt better when I woke up.

Sorry you're dealing with this. Let us know what you find out.

Julie

[erik]

I had similar symptoms, had mildly deficient "lung function test" with the doc & diagnosed with "adult-onset exercise-induced asthmaish thing". I've only had "serious" chest/heart/lung pain once or twice of mysterious origin (though I did cough blood once and still don't know why). Heart/chest will hurt when BP crashes and the heart struggles (if I'm in an orthostatic hypertension phase which comes & goes). I do have weird "heart skip or spasm" that brings an immediate temporary cough, like the lungs get over/under pressured briefly... but that's different than the "asthmaish thing" which is a non-productive and "episodic" cough that lasts 5 to 15 minutes typically and is generally associated with exertion but not always.

A simple albuterol inhaler seems to offset some of the shortness of breath and for a while I would use this prior to exertion and even just regularly for a while to see if it helped. I guess it did... and I was lucky not to have any side effect (most people don't but some do).

Also keep in mind that beta-blockers are notorious for exacerbating that sort of thing (though I'm not on them personally). People with asthma/allergies + dysautonomia get cornered in terms of treatment options... however, whats going on isn't necessarily just "regular old asthma".

[erik]

Oh yeah, I think Julie is referring to the simple test of deficient lung capacity/function where you just blow into a Spirometer. That's all I had and I was "lucky" enough to "blow a bad number" that day.

...vs. a provocative test, probably the methacholine challenge (though maybe there are a few others) where they induce asthma with a drug then relieve it. If you are "asthma prone" but don't happen to be very symptomatic all the time (as in conveniently for a test) this can be used.

Overall, one should consider semi-provocative heart exams too... like stress tests, heart measure during valsalva, laying on side, with various drugs and whatnot though I've not gotten that far yet.

[erik]

Apologies for running on... just wanted to add that I get "cycling" or periodic "come and go" with most of my symptoms, including periods of days/weeks when I am generally "short of breath". This can even mean I'll get a "drowning" feeling just from holding breath for a few minutes. Like the "CO2" sensor is really touchy during those times (remember breathing impulse is mostly driven by CO2 levels, not O2 levels). Those are distinguishable from the "asthmaish" periods... though they both involve some breathing stuff.

[valliali]

interesting, thanks guys. erik, have you ruled out pulmonary hypertension? i thought of it when you said that you had coughed blood before. it's rare and unlikely, but just wondering...

i will definitely have to consider some of these tests, especially one where they can induce the asthma. like i said, i am very frustrated with scheduling appointments when i'm symptomatic, then being fine when i am not and wasting a lot of money.

interestingly, today, i felt pretty okay with the chest tightness, like far, far better than yesterday. but then, shortly after i began driving somewhere with the windows down, it was like immediate chest tightness. i could actually feel it all inflamming/tightenting up. it was like my throat was closing and then i was just getting the 1/2 breaths. it lasted the whole hour or two i was out, then i came home, took an ibuprofen, and now feel a lot better. so it seems like something outside might be triggering this, but the pollen count is all low today. and the fact that the chest tightness comes and goes in these waves every six months is just strange. if it was a pulmonary problem, like asthma, wouldn't it be more chronic than episodic?

another thing is that about a year ago, i moved from my home in CA to my parent's home in Maryland, where i was planning to stay and help with my father's illness. when i left CA, i felt great. like almost normal. i drove cross-country, and as soon as i got out of the car in arkansas, i felt like i couldn't breathe. in fact, i couldn't. my lips were blue and i was just horridly short of breath. unfortunately, this symptom did not really let up the whole time i was on the east coast. it was especially bad on cloudy/rainy days. i felt like i was just constantly gasping for air, and i'd be pale and blue. i also had some other crazy symptoms (lots of tachy, immense pressure and whooshing in my head and ears at unbearable levels), but i wonder if, as erik said, my CO2 sensors were just whacky as a result of the high humidity and low pressure. actually come to think of it, the six weeks i somehow survived in maryland were probably the only times i remember actually feeling "POTS-y." i couldn't stand, as my heart would just race. it raced the whole time i was there, but i remember that laying or sitting felt much more comfortable. on the low pressure days, i couldn't stand. on days that were clear and sunny, i was okay. weird.

[erik]

Haven't had chance to rule it out but pulmonary hypertension has been in the back of my mind... I've been approved for sleep study and will get to it eventually (one very rare side effect of apnea can be pulmonary hypertension and apnea could explain a lot of my fatigue and other stuff... but so can POTS). Direct pulmonary pressure measure is pretty invasive so my doc & I have been waiting to see if I cough blood again (or if I just croak next time which makes things convenient If it happens again, some immediate imaging and angio stuff will be merited and could catch something.

Do you get a cough thing simultaneous with heart feelings (like flutter or pressure or tachy)? One of my phases is like that... and the other phase is very much like you describe with the shortness of breath. I'll also be short of breath and cough mid-sentence, more than gasp mid-sentence. But my coughs are virtually never "productive" (no phlegm)... although there are variants of asthma that are "dry". Like you, I don't think this is really "asthma" either... except in a *generic* sense as an "airway constriction" or whatever.

Your description sure sounds like a locational and seasonal allergy sort of thing on the surface, from the timing (though of course, heat/pressure/etc. could be involved instead). Seems like many POTS folks get hypersensitivities to stuff, either with or after their POTS... maybe even like a transient auto-immune flair up if your POTS is from auto-immune process... or I guess that's what an "allergy" is anyway!

One last thing, I will also tend to get my cough immediately upon standing... not all the time, just during my "cough sensitive phases"... did anything like that happen? Makes me think of "pressure problems" like the pulmonary hypertension (but a low grade version)... or even "hyper-reactive vasoconstriction" like what can happen to people with sudden low brain blood flow causing syncope (even without total body BP/HR drop). I can't escape the fact that much of POTS relates to "constriction" in vascular system (lungs have vascular + air constriction processes going on... and malfunction of that is "asthma").

[mountain girl]

I had similar symptoms, had mildly deficient "lung function test" with the doc & diagnosed with "adult-onset exercise-induced asthmaish thing". I've only had "serious" chest/heart/lung pain once or twice of mysterious origin (though I did cough blood once and still don't know why). Heart/chest will hurt when BP crashes and the heart struggles (if I'm in an orthostatic hypertension phase which comes & goes). I do have weird "heart skip or spasm" that brings an immediate temporary cough, like the lungs get over/under pressured briefly... but that's different than the "asthmaish thing" which is a non-productive and "episodic" cough that lasts 5 to 15 minutes typically and is generally associated with exertion but not always.

A simple albuterol inhaler seems to offset some of the shortness of breath and for a while I would use this prior to exertion and even just regularly for a while to see if it helped. I guess it did... and I was lucky not to have any side effect (most people don't but some do).

Also keep in mind that beta-blockers are notorious for exacerbating that sort of thing (though I'm not on them personally). People with asthma/allergies + dysautonomia get cornered in terms of treatment options... however, whats going on isn't necessarily just "regular old asthma".

yes, I also get "the cough" never productive, but feel it is often associated with the chest tightness and I feel short of breath alot like I need to take a deep breath. I am on a beta blocker, and a friend taking a beta blocker for high blood pressure said she thinks the cough is a side effect from the med. I can definitely feel tight and short of breath if it humid outdoors at all.

No dr. has ever mentioned asthma or allergy diagnosis to me, I just assumed it was part of the pots, and maybe it is for some of us, who knows.

[valliali]

Will the sleep study be able to indicate whether or not you have PH? I have heard that the PH tests are very invasive - have you had your PA pressure measured on an echo?

I do not get a cough, at all. Today, I woke up, feeling good. No shortness of breath. Biked down the road to work, chest tightness. I just feel like it is so difficult for me to get in enough oxygen, yet my capillary refill and mucous membranes all seem normal. I also have faint chest pain. When my chest gets tight, I also notice significant tachy, and way, way more palpitations. I'm having the "runs" of palpitations again, which I haven't had for at least a year thanks to propranolol. I don't know why this is connected.

This is similar to how I felt living on the east, though the east was much, much worse. But I find it unbearable. My joints actually weren't that inflammed or stiff this morning, so I am hoping this thing is on its way out, whatever it is. I don't actually feel sick or anything, so I have no reason to suspect a cold or virus. My body temp is around 97, as usual.

I'm sucking down Ibuprofen like candy, which is the only thing that seems to offer some kind of relief, though not as much as I'd like to feel comfortable.

Is anyone familiar with any problems of the diaphragm? Is it possible for it to become inflamed? Or out-of-position? It seems strange that when I push on my upper abdomen, I feel a lot more comfortable breathing. Is that just normal?

sorry you guys also experience this. It's awful. This chest tightness diminishes quality of life immensely!

[erik]

To my knowledge, you're quite right... the direct pulmonary hypertension test is very invasive. For me if the sleep study turned up apnea it would be like finding a *potential* cause, since that in rare cases can relate to PH... but wouldn't be anything conclusive. My incident seemed like a confluence of things that happened to come together at that moment and make a little rupture in the lung... like heart beating too fast & hard while the lungs were filled and pushing back and maybe some vascular & airway constriction weirdness as we tend to get with POTS... ironically it was when my "asthma" started so something was going on.

I think I have seen the chest tightness/pain on POTS symptoms lists, but it doesn't necessarily mean one should "write it off" as inevitable. Subtle heart things feed in to lung symptoms (since the heart so directly pumps in to them) so that's always worth considering. The fact that pressing on the area gives some relief is perhaps a helpful clue to someone with some good anatomy and diagnostic experience (I'm just an amateur guesser Definitely mention that to a diagnostician of some sort! I almost wonder if a combo "cardio stress test" and "provocative asthma test" could be done! Since you can provoke it (at least for the time being)... maybe a holter monitor with a little exercise? (just to be sure it's not a subtle arrhythmia)

I used to feel better wearing a "kidney belt" (or something designed for back support that holds everything solid). That could come in handy perhaps. Also, as in my case, "exercise induced asthma" is a decent match to symptoms and "tightness" can substitute for actual "cough"... even if that's not what is really going on. I think it's a "pressure balance" thing... lungs are quite sensitive to all that! I've busted a few ribs and partially collapsed a lung so I do know that! Ironically, it didn't hurt so much but was more of a "discomfort"... when stuff interrupts your basic life functions it is horrible! I guess that's obvious, but I think people not used to autonomic variations (even non fatal ones) just don't grasp that... even doctors.