Mysterious shortness of breath: What has helped you?

@sal51- Good morning doctor and thank you once again for saving the day with reassuring knowledge and personal experience. It stands to reason that if tests are confirming that there is no illness or disease that causes SOB that it is in the mind. It's definitely not reassuring and difficult to accept that our minds might be working behind our backs! How can people who have COVID-19 not have lung involvement or damage?

To answer a few questions-
There is a spectrum of disease due to COVID-19. Most people do not have lung involvement or damage- the few who end up hospitalized or passing away often do. There is a significant number of patients who are even asymptomatic or minimally symptomatic and they will not have lung involvement. In my case, I have chills, fatigue, headache, etc but no cough or other respiratory symptoms.

In terms of treatment, there is really no set treatment and that is part of the problem; again, this only applies to those who have normal testing for the usual causes of shortness of breath. As I mentioned, if you read posters, you will read a wide variety of things tried with varying degrees of success. If someone has underlying reflux, including laryngopharyngeal reflux, treating that is reasonable. There is debate about the varying breathing exercises that are mentioned; it does make some sense to me to try to avoid overbreathing to break the cycle you can get into- in other words, when you are driven to sigh/take that deep breath, try not to do it because you really don't "need" to do it from a physiologic perspective.
A trial of an antidepressant is reasonable. SSRI/SNRIs are the most commonly used medications; there is a paper regarding the benefit of amitriptyline in hyperventilation; amitriptyline is an older antidepressant which has positive effects in a number of conditions.
I think psychotherapy may be helpful for some.
At the end of the day, accepting the problem and then trying not to focus on it is probably as important as anything and over the time the hope is that it will fade.
In terms of some of the medical causes that have been mentioned- I'm not aware of any medical condition in which an isolated high bilirubin would play a role; that being said, if a lab abnormality is found, it should be explained.
Many mention allergy testing- airborne allergy does not cause this condition. If testing is performed and you are found to be allergic, treatment would address the typical allergic rhinitis symptoms (nasal/eye) but would be very unlikely to matter from a perspective of this breathing condition (outside of a possible placebo benefit).

Hi I am new to Mayo connect. Prior to January I was hiking and working out at the gym then out of no where I became SOB and had tachycardia. I had an abnormal EKG, abnormal stress test but a normal angiogram. I had a normal ct scan of my lungs and a normal echocardiogram. I saw the pulmonologist and he said that I had asthma and put me on asthma meds. The meds made no difference for my tachycardia and SOB would return when I tried to be active. The cardiologist doesn’t think that it is asthma and my pulmonologist doesn’t think that it is cardiac related. I don’t know what to think but I know that something is wrong. Does anybody have any ideas?

I am a physician with knowledge of the condition many posters experience- knowledge based on seeing patients with it and experiencing it myself. I have previously posted but realize many haven't read all the posts. This post concerns those who have dyspnea/shortness of breath concerns that are unexplained after extensive evaluation and doesn't refer to those who are determined to have a cardiac or pulmonary cause. The general term given is dysfunctional breathing and there are different forms. The classic example is patients who hyperventilate (breath rapidly in excess of a normal rate of breathing); many posters experience air hunger or the feeling of not obtaining enough air which prompts them to take exaggerated inspirations/deep sighs; many mention yawning which is typical.
The exact underlying cause of this condition is not clear. It is generally agreed that there is a derangement in the ventilatory drive which is the natural control mechanism of breathing. There is an idea that you can become overly sensitive to CO2 leading to the increased ventilation rate or depth. There are various factors that impact the ventilatory drive but there are certainly psychological aspects to it which is why anxiety is often suggested as an underlying cause but it may not be as simple as someone being anxious and therefore short of breath. In my case, I have found underlying psychological stress about something to often be a factor. I feel many on here take issue with the introduction of a psychological basis for this symptom and perceive the doctor as blowing them off but it is a valid consideration, particularly when test after test for organic disease is reassuring. The fact that the condition may have origins psychologically should not be taken to mean the condition is not real because it definitely is and there are many somatic manifestations (physical symptoms) of psychiatric disease that are just as real as symptoms that have an organic basis.
Unfortunately, the general knowledge of this condition is lacking among most practitioners which leads to frustration in those experiencing it because it is difficult for most doctors to address patients who are so symptomatic but yet have no abnormalities on normal tests.
There is no agreed upon treatment and when you read through the posts, there are a wide variety of responses to a wide variety of treatments. Some have reflux and improve with treatment; some mention psychiatric medications; some do breathing exercises, some take various vitamins/supplements.
I suspect the most important aspect of improving is acceptance of the condition and a belief in whatever treatment that is pursued. The fact that typical tests are normal should provide reassurance- I understand that for many, normal tests leave them with unanswered questions/ wondering what's wrong but it is a good thing to not have heart or lung issues.
Some mention having had COVID as did I and breathlessness is one of the symptoms of long COVID so it will be interesting to see how this plays out as the understanding regarding COVID and its effects on people are better studied/understood. The primary question I would have is if you can see breathlessness in long COVID in patients who did not have lung involvement when they were actually sick with COVID.

@gabe79- Good morning, it's nice to meet you. I know that it's very difficult to think that our minds work so secretly behind our backs. I think that because the medical community really doesn't have a defined cause for SOB that it would benefit all of us to keep an open mind.

If you were to take an antidepressant or other similar medications to help your SOB how would that be a waste of time? WHy not exhaust all possibilities?

@peterson- Welcome to Mayo Clinic Connect. I'm so sorry that you are having all these problems plus doctors who don't agree on the cause. It's enough to give anyone added stress. I would think that after your test results show more problems with your heart that you might want to follow up with your cardiologist.

Mayo Clinic has a wonderful explanation and video explaining all about tachycardia and how why it causes SOB.

What did your cardiac physician say would be your follow-up? After watching this video and reading the blog, what do you think?

My cardiologist said that I should make an appointment with a cardiologist at The Mayo Clinic where the pulmonologist and cardiologist work together , I have a appointment on June 26. The video was very helpful. It gave me some hope that a cardiologist might figure out what was wrong

@peterson- Good morning. I'm glad to hear this. Videos often help me understand things. I like demonstrations, they stick like almond butter.

Will you let me know how things go? What does your doctor say about how to deal with this until your appointment?

My cardiologist quit so my pcp has been monitoring me. He put me on ditizem which is helping. I see a pulmonologist next week. I don’t particularly trust the pulmonologist. He just dismissed the cardiology symptoms as nothing to be concerned about. My pcp is wonderful though.

@peterson- I had to look up your medication as I don't have heart problems. "Diltiazem is used to treat high blood pressure and to control angina (chest pain). Diltiazem is in a class of medications called calcium-channel blockers. It works by relaxing the blood vessels so the heart does not have to pump as hard. It also increases the supply of blood and oxygen to the heart.

It's always wonderful when I find a doctor who I trust and really like and who is upfront with me. Since your heart is so important do you think that you will be looking for another cardiologist? I recommend that. PCP's are terrific, and some are brilliant but they aren't specialists. You need a heart specialist. Can you get a recommendation for one? And also for a new pulmonologist?