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Breathing problem
Dear Doctor,
I would like to seek your advice regarding my 80-year-old father.
In 2025, he was admitted to the same hospital with heavy breathing and discomfort in his lower chest and upper abdomen. He was diagnosed with acute gastritis, and we were told that his breathing difficulty could be related to the gastric problem.
In 2026, he was admitted again with almost identical symptoms, including heavy breathing and chest discomfort, but without pain or cramps in his chest, jaw or arm. This time, he was diagnosed with acute left ventricular failure (LVF).
We are confused as to why similar symptoms led to different diagnoses on these two occasions. He continues to experience these episodes, particularly after lunch and his afternoon sleep.
Could you please advise whether these recurring symptoms could be related to gastritis or acid reflux, or a cardiac condition ?
Answers (9)
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If you would like to discuss your concern in more detail, please feel free to contact me on WhatsApp at eight six one nine six six nine nine zero six. Alternatively, you can connect with me through the Practo app for a detailed consultation
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Hello,
I understand your concern regarding your father's recurring breathing difficulties.
At 80 years of age, with a confirmed history of acute left ventricular failure (LVF), repeated episodes of breathlessness and chest or upper abdominal discomfort should be considered potentially cardiac until proven otherwise.
Heart failure can cause fluid accumulation in the lungs, resulting in breathlessness, particularly when lying down (orthopnoea) or during sleep.
Although gastritis and acid reflux can cause upper abdominal discomfort, they should not be assumed to explain significant breathing difficulty.
Additionally, older adults may experience cardiac ischaemia without typical chest pain, jaw pain, or arm pain.
The two diagnoses are not necessarily contradictory; cardiac and gastrointestinal conditions can produce overlapping symptoms.
Next Steps
If he is currently experiencing breathlessness or chest discomfort, take him to an emergency department immediately. Even if symptoms have settled, arrange urgent cardiology assessment. Recommended investigations may include ECG, 2D echocardiography, chest X-ray, BNP/NT-proBNP, kidney function, and electrolytes. During an acute episode, troponin testing may be necessary to exclude myocardial injury or acute coronary syndrome. Review his existing heart failure medications, blood pressure, oxygen saturation, and fluid status with his cardiologist. Maintain a record of daily weight, blood pressure, breathlessness episodes, and any ankle swelling. Gastrointestinal evaluation can be considered after significant cardiac causes have been excluded.
Health Tips
Encourage smaller meals and avoid lying down immediately after lunch. However, do not assume that symptoms occurring after meals are necessarily caused by gastritis. Follow his cardiologist's recommendations regarding salt and fluid intake. Avoid changing prescribed heart medications independently. Seek emergency care for worsening breathlessness, chest pressure, fainting, confusion, bluish lips, or difficulty breathing while lying down. My recommendation: Given his previous acute LVF diagnosis and recurring episodes, a cardiac cause must be prioritised. A cardiology review is essential to assess heart function and optimise treatment. With appropriate management, many patients with heart failure experience substantial symptom improvement. Wishing your father good health!
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