Q:
I have a question about my father — a 74 year old man in relatively good health. He’s fairly active – but has asthma and is about 20 pounds overweight. His breathing has been declining rapidly and the PA at his asthma doctor’s office put him on Prednisone and antibiotics for one week — and wants him to see a cardiologist if he’s not better. (That’s 3 days away — he’s not better.) He had a physical 2 months ago — told his doctor that he was feeling tired all the time — and the doctor told him he was just getting old. Would a heart condition causing breathing issues be picked up during a normal physical? How quickly should we get him to a cardiologist? I’m scared to leave him alone.
A:
Several issues:
- Acute episodes of asthma are often treated with steroids
- Difficulty breathing can certainly have a cardiac origin
- New onset of fatigue
Asthma is a chronic disease, and sometimes exacerbated by infections, colds etc. If it is indeed just asthma, a short course of steroids to break the bronchial spam often helps. Likewise, antibiotics may treat an associated infection. However, your dad should have responded by now. Also, this extra weight means additional work for his heart & lungs, so weight loss should be part of his treatment recommendations!
Questions:
- Does It hurt to take deep breaths, and if so, where?
- Is he more short of breath when laying down?
- Is he coughing a lot, and if so, is his sputum production increased. Normal/abnormal?
- Is his weight gain sudden or getting worse?
He needs a thorough physical exam and look for the following:
- Is the wheezing localized or diffuse?
- What does his heart sound like? (Heart beats regular vs. irregular)
- Does he have any swelling of his legs (peripheral edema)
Some tests:
- A Chest X-ray
- EKG
- Blood tests
All this could & should have been evaluated during his last office visit, but I would not be surprised if it wasn’t done.
Heart disease involving his valves, coronaries, or a poor function can produce asthma like symptoms, particularly in someone who is susceptible. A quick way to evaluate heart function is by cardiac ECHO.
I probably would order the ECHO together with all the other tests and then refer your dad to a cardiologist for evaluation if an abnormality shows up.
Hope this helps,
Dr T