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Forum Name: Cardiology Symptoms

Question: Difficulty Breathing, Chest Tightness and Light Headedness


 Braddockrd - Fri Oct 31, 2008 12:48 am

I am a 40 year old male. I quit smoking 2 years ago (although I never smoked too much), drink beer ocassionally, do not properly exercise but walk a lot and normal weight. I do not eat any vegetables and little fruits. My father died of stroke at 52. He had hypertension and arterosclerosys (blocked arteries). I have been experiencing anxiety symptoms on and off for a few years, due to many personal life issues. I had a full checkup done 2.5 years ago to analyse the symptoms and it concluded it was anxiety. I do not take any medications now, although at the time I was prescribed Celexa and it seemed to work (although maybe it was the placebo effect). The symptoms have lately become worse and I worry about heart problems and arterosclerosys due to my non-vegeterian diet. I have been experiencing an uncomfortable sensation breathing, like I cannot get enough oxygen and find myself needing to take long breaths. This sensation gets worse when I am outside, although some times it happens in the morning at home. It comes and goes. Often I also feel tightness in my chest. Additionally, I feel lightheaded and a little disoriented. Is it normal, even with anxiety, to feel all these symptoms and in such a recurring fashion? Many times is a feeling similar to that after having been running in the cold weather, where you are gasping for air and feel that light headedness associated with the cold. Also, if I eat a lot, it gets worse. Thank you
 John Kenyon, CNA - Fri Nov 07, 2008 10:05 pm

User avatar Hello -

First, given your history of anxiety as an established diagnosis, what you are describing is pretty classic for chronic generalized anxiety (GAD), which has a nasty habit of adapting, over time, and changing so that it seems something new is going on. This is not to say you couldn't have some new physical problem, although your symptoms are both vague enough and consistent enough with GAD (more about that in a moment) to justify an educated guess that you've simply worked your way into a new stage of the anxiety problem, it has mutated once again, and now it's time to address this new stage of the problem.

Part of addressing this would be to have a thorough physical exam, just to rule out any possible physical causes of any of this, plus the fact that you do have a positive family history for premature cardio and cerebrovascular illness (your father). You, yourself, sound fairly healthy, however. Still, by all means do schedule a physical exam for baseline purposes.

Now then, at the time of the physical, you should mention to your doctor that you are having new anxiety symptoms. The most telling one is your breathing problem, which, while it could possibly signal new-onset asthma, probably is not that. Your description of the sensation of inability to draw a full, satisfying breath, the resulting lightheadedness, etc., strongly suggests the deep sighing so often seen in both anxiety-plagued individuals as well as some with depression. What happens is the sighing starts out being an unconscious expression of being "weighed down" and when it is done, this throws off enough carbon dioxide (CO2, the gas which the brain uses to "know" when it's time to remind one to breathe) that the breathing impulse is stifled. It's of no harm whatsoever, but what then happens is the subject becomes aware he should be breathing and feels he can't get it quite right. Actually it's just that the brain isn't sending the usual "breathe now" signal. While breathing is a voluntary action, it is also a very deep reflex, and we are very aware of the need for it, even if we've been doing it wrong. So the CO2 balance gets thrown off, we feel unable to breathe properly, and begin to consciously sigh to get that satisfying "full breath" feeling. Only it doesn't seem to work, because doing this just throws off more CO2, tricking the brain even further. Eventually what happens is called hyperventilation syndrome,which means, very simply, symptoms caused by overbreathing. Those symtpoms normally include lightheadedness (which only makes us more certain we need to breathe even more), numbness and tingling around the mouth or in the fingers, and sometimes a vague feeling of mental disconnection. Consequently we assume there's something bad happening to our breathing or heart, and try to compensate by breathing more: a vicious cycle.

Eating makes it worse because, as a rule, we tend to swallow air when we eat (aerophagia), which makes it more difficult to draw a full breath anyway, because the swallowed air (classic "gas") is trapped in the stomach and presses up against the diaphragm (the muscle which we use to breathe), just making the sensation all the more disturbing.

Often, once a person has had this explained, he then becomes more aware of what's happening and is able to control it better -- particularly by deliberately relaxing when the difficult breathing sensation starts, by breathing more shallowly and through the nose (which makes it more difficult to sigh), and sometimes he is then able to break the cycle and recognize it in the future. If not, sometimes a new antianxiety medication is in order, or perhaps cognitive behavioral therapy, which is a self-limited (as opposed to open-ended and sometimes seemingly endless "talk" therapy) special type of therapy which helps the patient to learn to manage the problem by becoming aware of how the symptoms are caused.

I hope this is helpful to you. Again, I do recommend a standard physical exam, but I believe you are in excellent health most likely, and I am all but convinced you're hyperventilating and mistaking it for a breathing "problem" when actually it is represenative of a too-good ability to breathe.

Best of luck to you. Please follow up with us as needed.

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