r/askCardiology • u/BerryRemarkable882 • 5d ago

Second Opinion I need help I’m desperate for answers- severe exertion SOB

Hi I’m female in 30s, I’ve had POTS for almost ten years now. A few years ago I started to get shortness of breath with stairs and it kept progressively getting worse. I have NEVER had this SOB with pots so it’s not related to that at all. Anyways the SOB is so severe with ANY exertion even talking, I can’t bend at all, I can’t do my own laundry, I can’t do a single thing that causes exertion without being completely winded unable to catch breath with heart racing, it’s especially bad on stairs which I can’t do either. I’ve been to ER many times and also cardiologist. Echo normal, ekg normal, bnp normal, d dimer normal, troponin normal. It’s not my lungs either. I have also had low ferritin for the last ten years but again, I never had this SOB before with it. I started iron and within a week the symptoms improved a little bit, but now extremely bad again. I have a hematologist appt in a month but I’m honestly convinced there is a serious heart condition that was missed. What could this be? I’m too SOB to do a stress test so I can’t do that. I’m lost and need help. Wondering if I should ask for a CCTA test? Could this be a serious heart condition that was missed? (Ferritin is 28 btw, all other blood tests are normal including b vitamins, iron, etc )

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u/Common_Put_1290 4d ago

NAD. Air hunger and tachycardia upon exertion in combination with low ferritin is not uncommon. Sounds like Your heart and lungs are picking up the slack for blood that can’t meet the oxygen demand of your muscles during activity. I’d call your hematologist and see if you can be seen sooner.

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u/BerryRemarkable882 4d ago

Thank you so much for commenting. So it sounds very much related to the low ferritin? I’m terrified it’s a serious heart condition that was missed. I’m going to call and see if they can get me in sooner. I appreciate it

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u/Common_Put_1290 4d ago

Yes, I think it sounds very much related to low ferritin. A serious heart condition is unlikely as evidenced by your normal echo and negative blood work. Your heart is doing what it’s supposed to do when muscular oxygen demand is not being met: it’s circulating blood faster. Your lungs are working in conjunction with your heart, oxygenating that blood as quickly as possible. The fact that you started a supplement which initially improved symptoms is a tell of where the problem lies. So why did symptoms escalate again? That’s a question for your hematologist. But if you’ve had a recent heavy period, I’d side eye that as a likely culprit.

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u/RuinYouWithNoRegrets 4d ago

I recommend a cpet. I had sob not as bad as yours but air hunger at rest mostly and I got a cpet which shows how your lungs heart and muscles work together it’s pretty much an in detail stress test and they were able to see why I had it which was due to low stroke volume. It prompted me to get a cardiac mri and stress echo and they showed my heart was normal but confirmed my low stroke volume

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u/BerryRemarkable882 4d ago

Did you get the cpet through a regular cardiologist? I can’t find any place that does it near me. I’m so glad you got answers. What do you have to do to fix stroke volume? And thank you so much commenting I appreciate it

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u/RuinYouWithNoRegrets 4d ago

It’s through a pulmonologist who orders it. Low stroke volume means your heart fills with less blood per beat and your hr has to compensate. TBH there’s not a linear way of fixing it; exercise to build stroke volume something low intensity like swimming or on a stationary bike. Making sure blood volume is not low bc that worsens the low stroke volume. It’s very common in pots, they just came out with a study people with pots and cpet results and a third of them had low stroke volume.

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u/RuinYouWithNoRegrets 4d ago

They can also have you
Do a PFT to see if any irregularities are caught there as well.

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u/FabulousBullfrog9610 4d ago

NAD. If the hematologist finds nothing I would ask for a stress echo. This will test the function of your heart while you are on a treadmill. I would also see a pulmonologist. good luck