Can hypertension cause shortness of breath?

Question

Hello doctor,

I am a 56-year-old male experiencing musculoskeletal problems. Fourteen years ago, I was diagnosed with bone tuberculosis and underwent treatment. The condition recurred four years later and I was diagnosed with ankylosing spondylitis (AS). Despite receiving biological injections for 10 years, their efficacy diminished, severely affecting my mobility. Ten months ago, another rheumatologist suggested that it might not be AS and recommended massage therapy. I sought a second opinion from another rheumatologist, who also confirmed that it is not AS. She diagnosed me with myofascial pain syndrome, while another pain specialist referred to it as fibromyalgia. As it stands, I am uncertain about the diagnosis; it may be either myofascial pain syndrome or fibromyalgia. Following their advice, I have stopped all medications for AS and am continuing with massage therapy. My mobility is very limited, but I have seen some improvement (approximately 500 meters once or twice a day).

Regarding my heart condition, I have been experiencing issues for the past ten years (admitted for AS). I have undergone several ECGs and echocardiograms. I had an angiogram because I could not complete a treadmill test. I have included all these details in the attached documents in chronological order for your reference, along with my latest blood test report. Currently, I am experiencing mild shortness of breath (age-related) while walking 500 meters, which subsides within two minutes after walking, but there is no accompanying pain. I do not have any difficulty walking shorter distances. In the past, I have experienced a squeezing sensation in my chest (costochondritis) lasting up to one minute on multiple occasions, but I have never felt pain elsewhere. When I informed my rheumatologist earlier, he mentioned that if the symptoms were severe, they could be investigated further. Therefore, I have not given it much weight, assuming it is non-cardiac in nature.

My concern is that whenever I take an ECG, I am frightened by the possibility of a heart attack. Ten months ago, I went to the hospital for vomiting and was admitted to the ICU. They conducted blood tests, an echocardiogram, and reviewed my angiography report. There was no indication of a heart attack, and I was discharged. Five months ago, a doctor diagnosed me with hypertrophic cardiomyopathy (HCM), stating that it has been present since childhood. The ECG showed an abnormality, but I was told not to worry, advised against strenuous activity, and prescribed medication. I consulted the doctor who attended to me ten months ago, and when I inquired about the ECG abnormality, he did not acknowledge HCM and suggested that a mild heart attack had occurred. I have never experienced any difficulties related to a heart attack on any previous occasion, which adds to my confusion.

The echo impressions on various occasions have included: grade 1 impaired left ventricular diastolic function, concentric left ventricular hypertrophy, and hypertrophic cardiomyopathy. The ECG showed left ventricular hypertrophy (LVH) in four of these reports. My height is 5 feet 4 inches, my weight is 143 pounds, and my blood pressure is typically between 120 to 130/80 to 85 mmHg, with a pulse that is normally slightly elevated at around 90. Currently, I am taking Angizem CD 90 mg once daily, Clopilet once daily, and Roseday 5 mg once daily. Angizem has caused mild swelling in my feet. My CRP level is 5.1, which is the first time it has shown a higher value.

I kindly request you to review the attached reports. I would like to know the following:

What is my current condition—HCM or something else?
Has any heart attack occurred?
Why is my ECG consistently abnormal?
Is this problem related to a musculoskeletal issue that is non-cardiac?
Is the sensation of squeezing in my chest cardiac-related?

Additionally, I would appreciate any advice you may have and any medication recommendations.

Answer 1

Hello,

Welcome to icliniq.com.

I have reviewed your reports and summary (attachment removed to protect patient identity). You do not have hypertrophic cardiomyopathy (HCM), nor have you experienced any heart attacks. The changes observed in your electrocardiogram (ECG) are referred to as a strain pattern, which is attributable to hypertension. Similar hypertensive changes can be seen in your echocardiogram as concentric left ventricular hypertrophy (LVH). Furthermore, your angiography—considered the gold standard for diagnosing heart attacks—showed no major problems. Therefore, you do not need to be concerned about your heart status at this time.

Currently, you only have hypertension and some slow blood flow in your heart arteries, which is not worrisome. Your high-sensitivity C-reactive protein (hs-CRP) and fasting blood sugar levels are elevated, but there is no cause for concern. You are already taking Rosuvastatin, which is beneficial for patients with elevated hs-CRP levels.

Regarding your medication, Diltiazem is not currently a preferred choice for hypertension, especially since you are experiencing swelling in your legs. I recommend switching it to Telmisartan, taken once a day.

Your primary focus at this time should be on maintaining a healthy lifestyle and managing your blood pressure (BP). To achieve this, consider the following:

Avoid fatty, oily, and high-calorie foods.
Follow a low-salt diet and monitor your blood pressure regularly—three times a day for one week, then once or twice a week thereafter. Your BP should not consistently exceed 140/90 mm Hg.
Engage in regular exercise, such as brisk walking or jogging, for at least 30 minutes a day, five days a week, depending on your capacity.
Incorporate plenty of green leafy vegetables, fruits, and fish into your diet (once or twice a week), while avoiding meat.
Refrain from smoking and limit alcohol consumption.
Ensure there is no abdominal fat deposition or obesity.

I hope this helps you.

Thank you.