Help with diagnosis

From: Rajiv Sambasivan (rsambasivan_at_yahoo.com)
Date: 08/06/04 

Date: 5 Aug 2004 17:50:13 -0700

I am a 33 year old male whose case is as follows. About 5 years ago, I
began having episodes of palpitations and shortness of breath. Visits
to the emergency room as well as consultation with my internist at
that time showed no abnormalities. My internist at that time felt that
these were panic/anxiety attacks. However these continued and I
consulted a cardiologist who ordered an echocardiogram and a stress
test. Both came back normal and the cardiologist reported no
abnormalities with my heart and said that cause was not my heart.
Since that period was a particularly stressfull period of time, I
attributed these symptoms to the stress. I used to consume a lot of
coffee and cafienated beverages at that time. I completly cut down on
caffeine. Gradually the symptoms subsided. My blood pressure at that
time was mildly elevated in the 130-135/90-93 range at times. Most
times it seemed normal in the 120/80 range, and sometimes it appeared
elevated - I monitored/monitor my blood pressure at home. My internist
did not treat me for hypertension.

Over the next five years the only problems that I had were difficulty
sleeping at times and orthopnea - I would at times wake up choking for
breath at night. I slowly fell back into the habbit of drinking
caffeinated beverages again. Last year I went through another
particularly stressfull period and I started experiencing shortness of
breath on several occasions. I visited my internist who did a
complete physical exam. My cholesterol was elevated (220) but
everything else was within normal limits. My internist wants to try
the diet and exercise regimen first before starting me on medication.
Since the shortness of breath symptoms continued my internist ordered
an echo cardiogram. The results from the echo cardiogram showed that
all dimensional paramters of the heart to be within normal limits and
an ejection fraction of 65 %. However there was mild mitral
regurgitation. The report mentions the following as the impression: "
Good systolic function, no wall abnormalities. Mild mitral regurg". My
internist said that he was not too concerned about the mild mitral
regurg and that as a prophylactic measure I should take one dose of
antibiotics before any dental work. He feels that the shortness of
breath is not because of the heart and that at this time there is no
need to investigate the heart further.

Other information that may be of relavance is as follows:
(1) The shortness of breath seems to be related to occur with the
intake of caffienated beverages. I drink about 3 - 4 caffienated
beverages a day.
(2) I DO NOT HAVE any shortness of breath symptoms with exercise. I
have been on an exercise regimen for the past 8 -10 weeks or so and I
walk about 2 miles on the tread mill everyday at 3.8 - 4.0 mph and
have no shortness of breath during or immediately after exercise
(3)I do not smoke and have not for over seven years.
(4) My blood pressure at the doctors office seems to be normal (120
-110/70-82). However I monitor this often at home everyday and it
sometimes goes as high as (130/90-93).

My questions are:

Do I need to be under the care of a cardiologist right now or should I
continue with my internist. The shortness of breath and orthopnea seem
so suggestive of a cardiac condition.
The shortness of breath and orthopnea are bothersome at times. Given
the investigation done so far, should I be examined for other causes
for the same symptoms. If so, what are other things to examine ?

Relevant Pages

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    ... >> began having episodes of palpitations and shortness of breath. ... >> an echo cardiogram. ... internet, orthopnea and shortness of breath seem to be the most common ...
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