No breathlessness when walking and climbing, but anxious

Hello @jfching, and WELCOME to Mayo Connect! If I understand correctly, you have had heart failure in the past, but all your tests of late show really good news?
https://connect.mayoclinic.org/comment/955016/
To me that is awesome and totally was not a waste of time or money to learn your heart is doing really good.
Big sigh of relief!
I love how you say you feel so good when you exercise and your mind clears...that sounds like a super positive motivation to keep doing something really good for both your mind and your body.
Win/Win 🙂
I know for myself, having HOCM and feeling like I might die at any moment due to SCD (Sudden Cardiac Death) it really did a number on my heart and my head! I was in my head a lot, and there were times I wondered if I would wake up dead in the morning. I was able to round-up those thoughts, capture them, and corral them together so I could manage them better. Thoughts are powerful and can control you, but you can control them too with practice. I prayed. A lot. That is what helped me. Others find meditation helpful. And one of the most beneficial treatments for almost everyone is exercise! Walking in nature is therapeutic. And walking is good for your heart and head. You have had some reassurance now from more than one cardiologist, so I hope that helps to hear. Hopefully you can let it sink in a little bit more each day. Just out of curiosity, did they look for HCM? (Hypertrophic Cardiomyopathy) I did not see you mention an ECHO was done, but you did have a cardiac MRI?

I think that is great, and potentially, reassuring news. The discomfort might be something like posture when seated, or just general myalgia, maybe related to the deeper breathing and stretching of the intercostal muscles and ligaments around them. Maybe....? If it goes away, that's a great sign. Even if it persists, does it do so when at rest, when moving around, all the time...? Again, if it's only when you are seated that you notice it, it might mean you need to correct your seated posture. A physical therapist could help with that. But, please do keep moving, work on good sleep, feel confident and proud of your great heart health. Some would kill for even one of the decent parameters you have...! 🙂

Hi, thank you for your encouraging reply, last July, I was asked to repeat ECG and 2d echo. cardiac MRI was done last August. I am wondering since I am on meds and have my regular three month check ups with positive tests, if arterial blockage can form suddenly, but I guess I am just overthinking. I know if there is a block and the heart is so pressured, simple walking or climbing 4 flight of stairs would be a challenge. I am not familiar with HCM, but i also had chest xray for heart enlargement plus ct scan. The cardio last October told me that I did not have a heart attack. My heart was just inflammed because my hypertension was so high (200 at that time) due to diabetes. The fear is so strong even though 2 cardios already assured me I am fine. I am 47 by the way, thus, I am really careful about my health.

Thank you so much, yesterday I had the greatest discomfort. I am fasting intermittently and had only oatmeal for lunch. The incident happened and I felt tightness in my chest and something sour rising up my chest as well. Then I stood up and everything went to normal. If it were a heart attack, it is 24 hours now so I must be dead already :). Kidding aside, I think my stomach was acidic. The tingling or the needle pain occassionally is felt when I slouch since I am on a desk job (online trainer). Thank you, I will make it a point to move around the office from time to time. Thank you for the kind reply..

Okay, this is an area where I have learned something...intermittent fasting. My question to you would be: why are you doing it? If it's to manage weight, you must also reduce your carbohydrate intake. When you fast, say at least 16 hours (which is about the minimum for any potential benefit), eating porridge/oatmeal, which is essentially 80% carbs, is going to shock you back into insulin response, which is what intermittent fasting is meant to help you BREAK!! The whole idea behind keto/low carb, is to minimize the insulin response so that you don't store unused calories in the way of fat. Fasting, and then loading on carbs, is entirely counterproductive.

I'll tell you more if you're interested, but I wonder if the discomfort you feel when you break your fast is due to the high glycemic index of what you eat at the time.

Thank you so much, so fasting should still be keto and not carbs, I learned something new today. Thank you. I lost around 20 lbs from 2 months ago due to intermittent fasting and eating mostly 1 meal a day.

You can have carbs when you do eat, but the idea is to minimize it. Each gram of carbohydrate encourages your body to produce insulin in order to regulate the amount of sugar in your blood. If you eat 100 grams, whether in potatoes, lentils, bread, donuts, milk, sweetened yogurt, candy, puddings, breakfast cereals of all kinds, your body will have to produce insulin in order to get your blood glucose level back down to a safe level.

Not all carbs are bad. Potatoes are good, just not five pounds at one sitting. Lentils and beans are fine, just not sweetened, and not a whole bowl of them. Again, carbs are not 'bad', but they ARE bad if you consume the typical portion that so many modern western citizens eats, something like 400 grams or more each day. If you can keep them under 125 grams each day, you should....SHOULD...find that you will lose weight slowly.

One caution about intermittent fasting: if you only eat one meal a day, and are generally going light on calories, you run the risk of resetting your 'set point' of your metabolism. The body will think you're starving, so it will reset your metabolism to a lower 'setting' and you'll burn fewer calories than you might think you need. This is counterproductive as well. So, don't fast every day or for several days running. I lost 20 lbs three years ago keeping carbs low, fasting for up to 36 hours, but only two days a week.

One other tip...if you get used to intermittent fasting and your body develops a facility moving between adipose consumption and carb use, or autophagy and regular diet, you make each fast more difficult when you start them because you'll get hungry if you break your fast with carbs, and then go on for the next day or so eating a lot of carbs. The body secretes grehlin, the hunger hormone, about four hours after consuming a quantity of carbs. This is due to the drop of blood sugar. Ghrelin makes you feel crappy if you let it build up and you don't eat. But, if you go low carb, fasting gets easier and it doesn't feel nearly so bad after that first four hours because you train your body not to produce so much ghrelin.

When you break your fast, eat more fat and protein, and try to limit that first meal to about 75 gms of carbs. Eggs, bacon, and a small dollop of home fries would be a good way to break your fast.

Thank you for the kind words, I feel it only when seated mostly, at times when standing but it goes away when I change position 🙂

Like with many things, keto has its range (variations). Originally it was developed to control seizures and it is good for that, but some more extreme forms are not sustainable, if seizures are not your problem. I remember during my Mayo Clinic Wellness Coach Training program, that keto diet was not recommended as a long-term dietary option.

I agree with @gloaming that you should not rule out all the carbs, as all carbs are not created equal and they also contribute to your gut biome. You may consider getting and reading "The 30-day Heart Tune-Up" by Steven Masley, MD who has a gentle, middle-of-the-road approach to heart healthy diet.

It is important to include in your meals both soluble and insoluble fiber (begin with a fruit, apple or berries), protein, healthy fats, but having up to 1/2 cup cooked minimally processed carbs is beneficial to your long-term health. The order of various foods that I just described, also helps with controlling your blood sugar spikes.

As far as movement goes, apart from exercise you may consider non-exercise physical activity every hour. 2-3 minutes of walking, sit-ups (if not too weird at the office :), bending forward and backward to stretch your spine a bit.

Try various things, in consultation with your cardiologist. Little lifestyle experiments and adjustments can go a long way. Observe how you feel and take what works for you.

Be healthy!
J.