[47F] With COPD and heart rate changes during coughing

Patient Description

A 47-year-old female with a history of asthma and COPD reports experiencing a moderate dry cough, which is chronic due to COPD. Recently, she has noticed that her heart rate drops into the 40s every time she coughs, a symptom that has been present for about three months and is worsening. She also experiences severe dizziness, suspected blackouts, and chest heaviness, which she rates as 7 out of 10 in severity. The patient reports palpitations, irregular heartbeats, and swelling in her legs or ankles. She has a significant family history of heart disease. Current medications include Albuterol (2 puffs 4 times daily), Ventolin (2 puffs as needed), nebulizer treatments, Lexapro (20 mg once daily), Wellbutrin (100 mg once daily), Xanax (2 mg 3 times daily), and amitriptyline (50 mg once daily). No known drug allergies.

Arora's Assessment

What might be happening

Based on your symptoms, there are a few possibilities to consider:

Heart Rhythm Issues: The drop in heart rate and dizziness could indicate a heart rhythm problem, such as bradycardia (slow heart rate). This can be serious, especially with your family history of heart disease.
Heart Failure: The swelling in your legs and the heaviness in your chest might suggest heart failure, where the heart isn't pumping blood as well as it should.
COPD Exacerbation: Your COPD could be worsening, affecting your heart and lungs, especially if you're experiencing increased coughing and breathing difficulties.

These conditions require immediate medical attention. Testing might include an ECG, blood tests, and possibly imaging like an echocardiogram to assess heart function.

What you can do

Seek Immediate Medical Attention: Please visit an emergency room as soon as possible. If you feel your symptoms worsening, call 911 or have someone drive you to the hospital.
Monitor Symptoms: Keep track of any new symptoms or changes, such as increased dizziness, chest pain, or shortness of breath.
Avoid Strain: Try to avoid activities that worsen your symptoms until you've been evaluated by a healthcare professional.

Remember, it's crucial to get a formal diagnosis and treatment plan from a healthcare provider. Your symptoms are concerning and should be addressed promptly.

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8 mo ago

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