Shortness of Breath

Overview

Shortness of breath (difficulty breathing, breathlessness or dyspnea) can be caused by lung problems, heart problems or other medical conditions including anemia. Most everyone has felt “winded” or short of breath if participating in very strenous exertion or physical activity or in extreme weather conditions or very high altitude. However when shortness of breath is prolonged and persistent or occurs in unexpected situations, it is likely is due to a medical condition that needs evaluation. And, if breathlessness is sudden and severe in intensity, even if it’s of short duration, it may warrant medical evaluation.

Heart failure is the most common cardiac cause of shortness of breath, especially if it is accompanied by swelling (edema) of the legs. In addition to breathlessness with exertion, a person with heart failure might have difficultty in breathing when lying down often leading to propping up of the head of the bed with many pillows or waking up during the night with shortness of breath. Heart valve problems such as mitral regurgitation, aortic regurgitation or aortic stenosis can cause shortness of breath. One can feel short of breath during an arrhyhtmia when the heart is beating very rapidly. A collection of fluid around the heart (pericardial effusion) can cause shortness of breath as can pericardial constriction (when the pericardium is chronically thickened or scarred, constricting the heart itself). While significant blockages in the coronary arteries (coronary artery disease) typically can cause chest pain or discomfort (known as angina which is due to myocardial ischemia), some people only experience shortness of breath as an anginal “equivalent.” Likewise, while a heart attack most commonly causes chest pain, a person having a heart attack might experience significant shortness of breath, with or without chest pain.

Since shortness of breath can be a sign of heart disease, often patients with breathlessness are evaluated by cardiologists. In addition to a careful history being taken and a thorough physical exam by a cardiologist, often certain cardiac tests might be helpful to rule in or rule out cardiac causes of shortness of breath. These tests include an EKG, echocardiogram, stress test (including stress echoor myocardial perfusion imaging) or a chest x-ray. Sometimes, it is difficult to determine if a patient’s shortness of breath is due to a lung problem or a heart problem and a patient will be evaluated by both a cardiologist and a pulmonologist (lung specialist) to help determine the cause of the symptoms. In addition, patients sometimes will not report that they are having trouble breathing but rather that they just “tire” or fatigue easily with exertion.

Written by and/or reviewed by Mark K. Urman, MD and Jeffrey F. Caren, MD

Last updated: 03/24/2013

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