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Thursday, August 21, 2014
I had a pulmonary embolism and infarct nearly a year ago. I have struggled to get my stamina back, and still can`t consistently count on feeling well on any given day.
Specifically, I seem to have problems after I exercise. I always feel well during exercise (which is mainly walking and occasionally riding an exercise bike). Up until recently, if I got my heart rate up at all (meaning 70 to 80% of max), I would feel great during exercise, but sometimes four hours later or the next day I would get bad chest pain and feel lousy and have to lay low for several days. Now, I don`t get the chest pain, but I don`t feel well at all the next day or the next several days(feeling like I`m going to pass out, or like my oxygen-carbon dioxide exchange isn`t quite right).
Does any of this sound like exercise-induced PH? I was told if it was that, I should be having chest pain and/or shortness of breath during exercise, not after. I don`t have any of that during exercise, and I feel so good during it and immediately after that it`s very distressing to continue to feel so lousy afterward.
My doctors have tested for cardiac stuff and don`t think it`s that. Echocardiograms have shown only a mild increase in pressure (32), and no right heart or valve changes.
I should probably also mention that I had a stress test five months ago, getting my heart rate up to 107% of max, and felt great during and for the next 24 hours after. Then I had severe chest pain and fatigue, and when I would try to do light exercise, I would feel fine, but would again have the chest pain after. (One time the pain was so sharp and severe that it brought me to my knees. I have a pulse-ox for exercise and it was nearby, and my ox-sat dropped from 96% to 92% during the sharp pain. My doctor told me maybe I had another PE? But I had a CT scan three months ago, and it showed no clots.)
I just want to feel well, and I`m so discouraged that this keeps happening. Have you ever had any experience with exercise-induced PH where all of the symptoms happened after exercise, not during? Or do my symptoms seem more in line with general infarct and PE-related issues?
Also, would a V/Q scan help determine or rule out anything in this area?
You have listed all the possible complications of a pulmonary embolism, and your doctors have evaluated you for those. Your echo did not show any elevation of pulmonary artery pressures, and the CT scan did not show a new clot. A V/Q scan may not be a bad idea to evaluate for chronic clots and some other pulmonary vascular problem. The sure way to look for pulmonary hypertension would be a right heart catheterization.
Namita Sood, MD, FCCP
Associate Professor of Pulmonary, Critical Care & Sleep
College of Medicine
The Ohio State University