I have shortness of breath, and I can hear my heart beat loud. Why?

Hi doctor,

I am a 34-year-old female and have been experiencing shortness of breath and increased heart rates for the past year. I also have palpitations and have been feeling extremely tired. I own and run a farm, so I am very fit, but I have been struggling with physical work due to these problems. During this time, I was also diagnosed with Hashimoto’s thyroiditis, and I am currently taking Levoxyl (Levothyroxine sodium), which has brought all my thyroid levels back to the normal range. I have talked to a cardiologist, but due to COVID-19, I have not seen him in person. He sent me for an echo (echocardiogram) which was totally normal, and it just showed mild mitral prolapse. The ECG (electrocardiogram) showed a right bundle branch block, which I have been aware of for many years and has never affected me. I wore a Holter monitor for ten days, and all it showed was an increased heart rate, mainly sinus rhythm, PVCs (premature ventricular contraction), and one episode of NSVT (non-sustained ventricular tachycardia). I went to a rheumatologist a few months later, and she sent me for a chest CT just to rule out any problems with my lungs. It showed that my lungs were totally normal, but it did show some pericardial effusion. She put me on Prednisone and Colchicine. I was unable to continue the Colchicine because it was causing abdominal pain, but I did finish the Prednisone. While on the Prednisone, after about a week, I did notice a marked improvement. I also did not feel exhausted and tired as I did before. I finished the Prednisone about a week ago, and I feel a gradual worsening of my symptoms again. My main reason for writing to you is to ask about a strange symptom: There is always a noise of my heartbeat that can be heard easily without a stethoscope, and it is louder through my mouth. It comes in the form of clicks and squeaks, in the exact rhythm of my heartbeat. It is mainly the clicks that are heard with a slower heart rate, but as my heart rate increases, the squeaks also become louder. Is this just something I should ignore, or could it be a sign of something? I did tell the cardiologist this during our phone appointment, but he did not seem to believe me. I have recorded the noises on my phone by holding it next to my mouth. I am hoping I can send them to you. The noise seems to have worsened recently. I also should mention that since these symptoms began, my blood pressure has significantly decreased. My blood pressure was perfect my whole life, and now it is always low, around 95/47. Not sure if that is relevant or not. Thank you so much.

Hello doctor,

Thank you so much for your response. My thyroid hormone levels have been consistently within normal range since I have been on Levothyroxine. The rheumatologist has done many blood tests for other autoimmune disorders which I believe includes connective tissue disorders. So far everything other than the antibodies for Hashimoto’s has been normal. For your interest here is a recording of the noise my heart makes. I recorded it by holding my phone next to my face. Thank you again.

Hi doctor,

I had a stress echo performed and the results are as follows. Is it anything to be concerned about? What should be the next step? I cannot get an appointment with the doctor for another month. Could this be the cause for my shortness of breath and fatigue? I am usually a very fit person. If the hypokinesis is not caused by ischemia what might be the cause? I already have two autoimmune diseases (Hashimoto’s and alopecia). Do you think sarcoidosis might be a possibility? Thank you so much.