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Heart & Cardiology/Nocturnal dyspnoea / Orthopnoea



I'm a 25 YO female, BMI 28.  Apologies in advance for my vague and many symptoms - they're a bit disorganised in my head so not likely to be much better here...  Also this is probably more ENT maybe but there is no ENT section so any insight you might have would be great...

(symptoms 6 - 12 months ish - it's insideous so i'm not sure)

* Sensation of pressure in my neck when I lie down like someone's pressing on my trachea a bit, worse when lying down.  
-----Pain in right shoulder intermittently also, shooting down about a 3-4/10, not too bad.  May be completely unrelated / benign.  
-----Also numbness in my 5th finger (baby) when I lie on my back in either or both hands, intermittently but this has been happening for years and years... (I'd wake up with numb fingers, shake them out)

* Difficulty swallowing liquids intermittently, whereby id choke/cough/go down the wrong way.  
------Sometimes this would happen with my own saliva if I breathed in, very annoying.  
------No problems with solids, no reflux, no other symptoms of neuromuscular disorders.  

* I am finding it difficult to breathe lying on my back, have always mostly slept on my front anyway.  Now though, if I roll over I will wake up on my back out of breath.  This has all been kind of insideous because I have over the last year or two put on weight so I thought it was maybe sleep apnoea...?
------- No dyspnoea with exercise
------- No signs of CHF or anything...

* Intermittently I was experiencing a sort of pleuritic type of pain whereby if I took a deep breath in, a sharp pain kind of below my left breast
-------didn't feel muscular - I've had chostochondritis before, it's a different type of pain...
-------difficult achieving a 'satisfying' breath, every couple of breaths I would have to really try and breathe deep, using my accessories.  I found this worse when I was eating for some reason it lasted a couple of months.  My GP basically suggested anxiety and I did doubt myself, but honestly know it's not that, as it has since resolved to my great relief and at the moment all is well with my breathing during the day.  Nice satisfying breaths.  Also my GP didn't really ask me questions or examine me at all, but did write me a referral letter for a Gastroenterologist incase I have an oesophageal diverticulum and put me on a PPI... even though I don't have reflux... I don't think he was listening to me at all but anyway, If I get the GI appointment maybe I can be referred on to an ENT or something.

* Weird thing I noticed tonight.  If I take a deep breath and hold it with my mouth open, I can hear a pulsatile (checked against my pulse and it definitely is) kind of soft wheeze sound.  When I close my mouth I can't hear it...My boyfriend can hear it too so i'm not totally crazy.

Review of other systems:  Random very low grade intermittent pain in RIF - less pain more like a sensation.  Feel it more if straining / increased abdo pressure.  Not annoying enough to query... maybe an ovarian cyst or very mild crohns?

Previous arrhythmia with syncope: Wide complex AVNRT with abberrant conduction recorded on loop recorder (6 mins at about 300 bpm), had a radiofrequency cardiac ablation in 2008, no further episodes.

Fam Hx:
Sister has Asthma

Travel Hx:
Within Europe only in the past yr

Nothing apart from the pill... (I self-discontinued the PPI after a month, and got some lovely rebound-reflux (thanks GP) but that has resolved now).

I don't want to tell you i'm a medical student incase you think I have globus pallidus like my GP clearly does, but I am a medical student.  Also, many years ago he thought my syncope was anxiety related also and eventually my arrhythmia was discovered so...  maybe I should get a new GP...

Thanks for any advice!

Hi Stacey,
You are following a typical pattern of medical students: self-diagnosis of diseases you have just learned about. None of your symptoms are cardiac and most pleuritic symptoms if true are associated with a friction rub! Don't worry, you'll get over it. However, your hx is significant for the 2008 ablation: that is not a perfect procedure and you should have it checked out again in case you have a recurrence even if your sx are not suggestive of an arrhythmia.
Meanwhile take a look at my website, roam around and see if that helps - come back to me if needed. There is some neat stuff about congenital heart disease - nothing to do with you, but the result of a course I gave to med students in the US:
Hope this helps,
Dr T

Heart & Cardiology

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