General Question

flo's avatar

Getting wiped out just for climbing one short flight of stairs means what?

Asked by flo (7462 points ) October 6th, 2013

My cousin just told me that her heart beats like crazy and that she needs to sit or lie down after walking even a short flight of steps. What should she do/not do before she gets to see the doctor?

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29 Answers

Rarebear's avatar

Absolutely no way to tell. Any advice you get here besides “go to the doctor” will invariably be wrong.

Sunny2's avatar

She may be getting old. It could be a heart problem or a breathing problem, but it needs to be tended to ASAP.

JLeslie's avatar

I’m in the go to the doctor camp. Get a stress test. No way we in internet land can diagnose her, and short of breath can be a serious sign of heart disease.

Having said that, is she getting winded just walking on flat ground? Walking 20 minutes at a normal pace? If so, it probably is not a cardiac concern, but still, the only way to be absolutely sure is to go to the doctor and be evaluated. If this is something new, not being able to walk up a flight of stairs, when previously she had no problem, she should take it seriously. My dad both times he had serious blockages in arteries around his heart was winded just walking a fairly short distance on flat ground, when previously it was no problem. Actually the first time he was short of breath. The second time he was getting some chest pain. Maybe because it was different arteries? Not sure. The occurrences were over 25 years apart. The first needed bypass surgery, the second a stent. With the second one the doctor actually told him to do the walking test a few days in a row. The first, the shortness of breath was just walking two blocks, his usual walk from his car to his work building. They didn’t even let him finish the stress test his results were so bad while on the machine. My dad never has had a heart attack, he always caught it before a significant event. Paying attention to symptoms has really benefitted him.

I get winded sometimes when going up a flight. In my case it is usually my thyroid is out of whack and add on if I am anemic, my heart can feel like it is going to pound through my chest. Then I get things back into sync adjusting my meds and taking supplements, and I am able to go up a few flights with no problem.

Also, if she does not exercise regularly, her stamina might just be very poor.

But, I say get checked, to be sure. If it is not cardiac, it could be something else, and some simple blood tests might help her on her way to feeling much better.

Is her resting heart rate very high or low? Is her blood pressure normal? I would check those things and call for an appointment.

marinelife's avatar

She needs to see a cardiologist who can order the right tests. Probably a stress test and an echo-cardiogram.

JLeslie's avatar

She could ask her doctor if she shoud take an aspirin a day as precaution until she is evaluated. I also recommend she avoid stress if she can, and she should not push herself. Elevators and escalators for now.

gondwanalon's avatar

This not something to put off until later or to monkey around with.

I suggest that your cousin go to the nearest Emergency Department ASAP. Some heart arrhythmias are life threatening and could cause a ischemic stroke if not treated. A simple ECG could yield enough information to same your cousin’s life.

I’ve lived with various arrhythmias for 12 years and I know how your cousin feels. One minute I was an athlete in terrific shape training for the Boston marathon and the next minute was an old man struggling to get around and especially going up stairs.

Good health.

CWOTUS's avatar

There’s no way of knowing whether this is a cardiac, pulmonary, circulatory or weight problem, or some combination of all of those, or something else entirely. Even the doctor who examines this patient won’t know without asking questions and observing what is presented, which we cannot see, obviously, and cannot believe with certainty just because you say it is.

JLeslie's avatar

Correction, if walking on flat ground for 20 minutes or less is difficult then it very likely is cardiac. Still, we can’t know for sure.

Seaofclouds's avatar

There are a lot of things her doctor will need to discuss with her. It would be a good idea for her to make an appointment as soon as possible. In the time before the appointment, she could keep a journal to keep track of what she is eating and what her activity is like. With the activity, she should include how she tolerates the activity (such as the shortness of breath, heart pounding, etc.). There could be numerous things that cause shortness of breath and fast heart rate with activity. The doctor will also need to know if this is something new or something that has been occurring over time recently. If it is new, if she can remember exactly when it started for the first time, that would be helpful. If it has been occurring over time, when it started and how it has progressed would be good to tell her doctor. Has it gradually been worsening or has it been worse and then gotten better and now getting worse again.

srmorgan's avatar

From real-life experience, I was walking between 2.5 and 3 miles per day two years ago this time of year. Slacked off during the winter. Early spring I am getting winded at a lot shorter distances. Not panting for breath, no chest pains, I just ran out of gas after a half hour of walking
Told the Dr, She orders tests, stress test was not good. Cardiologist sends me to the catherization lab and finds a blockage in an important artery.
Stent is implanted then and there. This was done on a Thursday and I was back at work on Monday. May of 2012.

Walked 16 miles (over three consecutive days) the last weekend in July this year as part of a competition at my fitness center.

IT IS BETTER TO BE SAFE THAN SORRY

SRM

cazzie's avatar

Asking questions about health problems this vaguely is pointless. Any other symptoms? how much does she weigh? any history of cardiac problems? Seriously. It sounds rather serious and could be a number of things. She needs to see a doctor.

I had other symptoms as well, but when I had this particular symptom, it was from an over active thyroid and it was a simple blood test that confirmed it… and then a lifetime of management of the condition.

Get her to see a doctor.

Cupcake's avatar

Well, for me it was bilateral pulmonary emboli. I almost died. Thank goodness I went to the emergency department and sat in the waiting room almost all night long.

flo's avatar

She was going to the doctor, (“What should she do/not do before she gets to see the doctor?”) but since she had no chest pain, even at the emergency, there is going to be some waiting involved, as @Cupcake poited out:
“I went to the emergency department and sat in the waiting room almost all night long.”

Thank you all, and good luck and continued health to those of you who survived and managing.

JLeslie's avatar

The problem with that is women often don’t have chest pain.

My dad had no chest pain when he needed bypass surgery. He did when he needed the stent. Different artery.

But, I am guessing they drew blood at the ER and her heart enzymes must have been fine. So that’s good. That is if my assumption is correct. I would guess they also hooked her up to an ekg.

Let us know what her doctor says. Make sure they test her thyroid if the hospital didn’t.

Cupcake's avatar

@flo How long does she have to wait to get in to see her doctor??

I just want to clarify that it was totally inappropriate to have me wait in the waiting room for many, many hours and that the triage protocol at my hospital has since been changed. Anyone who shows up at the hospital will go through triage immediately, where they will have their vital signs taken and (with her respiratory symptoms) and EKG. Those results should indicate whether she needs to be seen immediately.

I hope that she doesn’t have to wait long to see her doctor. Given my history, I would advise others to be seen immediately.

JLeslie's avatar

@Cupcake Fucking hospitals! I went to the ER over a year ago in horrific pain having been hospitalized and released, and then a couple days later had a major setback. They let me sit for almost an hour in tremendous pain. When the nurse cpfinally came to get me one of the things he said was, “I can tell you are in real pain.” That meant to me that reception, not a medical professional, had sized me up and decided I went to the ER to beg for drugs. I had drugs in hand already from having been hospitalized. I wrote a letter a couple weeks later at how horribly I was triaged. Their response was less than satisfactory. Almost a year later I was talking to a woman in my zumba class who works with the ER at that hospital and somehow the conversation turned to her telling me they now have a nurse triage. I stopped her mid sentence and asked, “so before the receptionists were deciding?” She said yes. I can’t believe that was actually the case, how in the world could that be the case? In my over 40 years of life I have never before not been triaged by a nurse. It just seems to incompetent. I wonder if my letter finally changed how they triage? I’m sure not my letter alone, but maybe it was part of the reason.

Cupcake's avatar

@JLeslie That’s ridiculous. Was it a tiny little hospital?? In my case, my mother was a part-time social worker in the ED and she complained directly to the medical director, who requested my chart, reviewed it and created an additional triage check… so it was a nurse who originally ignored my worsening shortness of breath, chest pain on exertion and elevated blood pressure in the setting of recently starting birth control pills.

Meanwhile I was literally sitting in a hard plastic chair surrounded by smelly sick people from 6pm on a Friday (after getting winded walking down 2 flights of stairs after work) until 2:30am. I still didn’t get a scan until ~11am and then had an anaphylactic reaction to the blood thinner, for which I received resuscitation at the exact moment that my 13 year old son came to my “room” to visit me (without anyone checking to see if it was ok to send back a visitor).

Shitty experience, but I am so thankful that I didn’t leave the ED waiting room as I had intended… because I really could have dropped dead that weekend.

JLeslie's avatar

@Cupcake Medium sized, fairly new, but part of a chain (is chain right?) of hospitals. It was St. Francis in Memphis, there is more than one there. The other one, the older one is larger. They might be connected to St Francis hospitals in other cities? I don’t know. I really could not believe it. Nothing like that has ever happened to me before. But, as you know all sorts of shit happens to me with medical stuff. Two weeks ago I did a test I wasn’t very keen on doing or paying for andnthe lab screwed it up and I have to get it repeated now. Seriously, I cannot believe how many crazy things happen to me. And, does more happen to me, or am I just more aware than most people? Almost every non routine medical prcedure I have had done had some sort of problem. It makes me afraid to try anything, and one day when I get afraid enough I will probably not do something that I really should have and die from it. I expect things to go wrng and for mistakes to be made, and when I am treated well and am well cared for I am shocked. Literally surprised. It sucks I hate it.

flo's avatar

@Cupcake “How long does she have to wait to get in to see her doctor??”
She is in a developing country temporarily, she doesn’t have a doctor. Good to know that you waited all night wasn’t a regular thing.

How does the triage nurse do the job? First come first serve basis? In so, there are going to be times while the triage nurse is assessing person x, patients with more urgent need of care (not visible to other people, let’s say with chest pain) arrive. What happens then?

JLeslie's avatar

@flo Chest pain moves to the head of the line usually. The triage nurse is usually only with a patient a couple minutes, they can move through patients quickly. They aren’t treating at all, just vitals and basic assessment of what is wrong.

What country is she in? My family by marriage lived in Mexico and Dom Rep, and actually I was treated by a doctor in Dom Rep, and it wasn’t difficult to get in to see a doctor.

CWOTUS's avatar

At its most basic level (after making a “possibility of life” decision – see below) triage is “4 Bs”:

Breathing
Bleeding
Broken
Burns

Someone who is not breathing has to be enabled immediately, or brain damage and then death will occur within just a few minutes.

Profuse bleeding can kill, too, but even heavy bleeding will slow within a few minutes (longer than it would take someone to die of oxygen starvation, even if “not much longer”) because of reduced blood pressure and the body’s natural reaction to clot and collapse arteries and veins as pressure reduces. So you have “a little” more time to treat that person.

Breaks can get worse very quickly, but they aren’t generally life-threatening. Compound breaks include bleeding, but not usually arterial bleeding, and infection under the skin, which is also dangerous. If you’ve got a broken leg – even with a bone sticking out of your skin – lie over there while we get this person breathing and then that person’s heavy blood loss stanched.

Burns, as painful and dangerous as they are, can be treated after those other injuries are handled.

Of course, any one of these injuries can also include shock, which can lead to heart attack / failure, unconsciousness leading to collapse, etc., and those things can lead to or cause worsening of additional injuries or new and potentially fatal injuries.

Triage, in general, is the process of managing your Emergency waiting room so that the most severely injured people – who still can be saved if treated properly and timely – can be saved with the least additional injury, and no death if possible. That also includes evaluating the condition of the person who comes through the door to determine “does he even have a chance at living at all if we devote resources to him now”.

If a drowning victim is wheeled into the ER, cold to the touch, pale and obviously not breathing, and the rescuers tell the triage nurse that he was underwater for a half-hour, he’s not going to move to the head of the line ahead of a person whose breathing has also “just stopped”. The warm body will be treated first if there’s a resource issue (there is nearly always a resource issue) because that person has a better chance of actually being saved.

That’s all “in general”. Like most other human endeavors, sometimes people aren’t sufficiently trained, and sometimes they make bad decisions even when they are.

flo's avatar

The triage nurse takes a long time, 10 minutes, somewhere there taking all the vitals filling out forms. And it is only the patients coming in an ambulance, that get the triage nurse’s attention. They don’t come out to see if there is a patient with something more urgent is sitting there waiting patiently.

cazzie's avatar

if it was so urgent, I doubt the waiting would be very patient, unless the person was particularly dense.

snowberry's avatar

Impatient patients don’t matter a bit to ER people. They deal with those types all day long. They are supposed to spot the bad cases in the waiting room, but it doesn’t always happen.

JLeslie's avatar

@cazzie I wait patiently usually, I did when I was in tremendous pain after a serious accident (I actually had trouble breathing and hours later they figured out I did have a small pneumothorax, but they had excused it as anxiety, even though I was extremely calm the entire time I was there, except two hours into it when they basically abused, not related to the lung tear, they caused me severe pain for absolutely no reason, I would tell you the story but I am sure it will just sound like ranting). Anyway, when I was first admitted in the ER and when I had to return a few days later I waited while in bad pain for a very long time. As you know I am pissed off at doctors quite often, so generally I try to be passive, compliant, and not complain. They have successfully beaten me down. Although, after this last stint I am pretty sure I will try the crazy bitch from hell next time if being calm does not work. But, the problem is they take it out on you when you aren’t an easy patient. It is an impossible line to walk.

snowberry's avatar

@JLeslie It really helps to have someone with you to speak for you, to keep an eye on them, to be a witness to any shenanigans, etc. (because they don’t always have your best interests at heart).

JLeslie's avatar

@snowberry I usually do, My husband was there in both instances. Although, he was out of the room when they hurt me badly and ignored my pleas, and it definitely would have helped in that moment to have him there. He would have told them I have an ongoing problem, that I am not being hysterical, and that they absolutely really are causing me tremendous pain when there was another easy option, and to fucking listen to me.

He can only go by what I tell him though. If I am being passive, he isn’t going to start telling the doctors to do something if I am perfectly able to speak. Meaning if I was unconscious he might take it upon himself to question things more. He did during my hospital stay try to get help more than once for a deep cut that was not healing (it should have been stitched) and they did not treat it correctly. I could not see it in the location it was in on my body. When I finally could I knew what needed to probably be done and we went for medical attention to get it fixed. I had already been discharged out of the original hospital though.

snowberry's avatar

@JLeslie (snowberry shakes her head) I keep hoping to hear good news from somewhere about our “modern, professional” medical system. Instead I hear more stories to confirm my doubts and previous experiences about it.

flo's avatar

If the door sign says to (the patients) not to knock and disturb the triage nurse, what is a patient supposed to do? Even if there is no such sign, is the chest pain patient expected to do? “Nurse I’m sure I must be more urgent that the patient you’re seeing”

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