Shortness of breath (dyspnea) is a common symptom. Sometimes it is related to something temporary (such as a respiratory infection, stress or poor physical condition), but it can also be a sign of a heart, lung or blood problem. The important thing is to identify when it is an emergency and when a cardiology evaluation is appropriate.
The most important
- It is urgent if shortness of breath appears suddenly, is intense, occurs at rest or is accompanied by chest pain, fainting, confusion or purple lips or fingernails.
- It may be heart-related if it worsens with exertion, if it appears when you lie down or if it wakes you up at night with a choking sensation.
- You can't always tell the cause just by “how you feel”. If it is a new symptom, repeats or limits your daily life, it is worth evaluating.
What is “shortness of breath”?
It does not always feel like “I'm short of breath”. It may present as:
- You get more tired than usual with daily activities (walking, climbing stairs, carrying bags).
- Feeling that “not enough air is coming in”.”
- Tightness of breathing
- Need to stop to catch your breath
- Choking at bedtime
When is it urgent?
Seek immediate medical attention if shortness of breath:
- Appears suddenly and is intense
- Occurs at rest and prevents you from speaking complete sentences
- Accompanied by pain or pressure in the chest, cold sweat, nausea or paleness
- Accompanied by fainting, confusion or marked drowsiness
- There is purple/bluish coloration of lips or nails.
- Rapidly worsens
If there are also chest pains, check for chest pain: common causes and when is it an emergency? when it is published. You may also find this article on acute myocardial infarction.
Clues that it may be of the heart
These signs alone are not diagnostic, but they do indicate that a cardiological evaluation is advisable.
Shortness of breath with exertion
You are short of breath when walking, climbing stairs or doing activities that you used to tolerate. If this is increasing, it's an important finding.
Choking at bedtime
You need more pillows or feel short of breath when you lie down. Many people describe it as “I have to sit up to breathe better”.
Waking up at night with choking sensation
You wake up in the early morning with shortness of breath and need to sit up or walk around a bit to feel better. If it happens again, it is worth checking.
Leg swelling or rapid weight gain
Fluid retention can accompany heart pumping problems. If you notice swollen ankles or gain several kilos in a few days without explanation, do not ignore it.
Palpitations along with shortness of breath
If you feel irregular or very fast heartbeat with shortness of breath, check also palpitations: common causes and when to worry about them and, if applicable, arrhythmias and atrial fibrillation.
Frequent causes (heart and others)
Causes of the heart
Heart failure
It can cause shortness of breath with exertion, when lying down or at night, as well as fatigue and fluid retention. You can read more in cardiac insufficiency.
Problems with blood supply to the heart (ischemia/angina)
In some people, the main symptom is not pain, but shortness of breath on exertion, especially if there are risk factors.
Arrhythmias
Very fast or irregular heartbeats can lead to shortness of breath, fatigue and decreased exercise tolerance.
Other common causes
Respiratory
Asthma, respiratory infections, bronchitis or pneumonia can cause shortness of breath, coughing or “wheezing”.
Anemia
May cause shortness of breath with exertion, palpitations and fatigue.
Poor physical condition or weight gain
After a sedentary lifestyle, prolonged stress or weight changes, it is common to become more tired. Even so, if the change is noticeable or rapid, it is worth evaluating.
Anxiety
It can cause rapid breathing, tightness and choking sensation. Important: Just because it looks like anxiety does not mean it always is. If the symptom is new, strong or accompanied by warning signs, it is checked.
If you feel that stress and sleep are playing a role, you can complement with stress, sleep and heart health.
What the evaluation with the cardiologist may include
The evaluation seeks to rule out important causes and choose the most useful study according to your case. Depending on your symptoms and history, it may be indicated:
- Electrocardiogram (ECG) to review rate and indirect data
- Stress test if shortness of breath occurs with activity
- MAP 24 hours if there is suspicion of poorly controlled blood pressure
If you also have hypertension or variable numbers, check blood pressure: goals and measurement at home and the article by hypertension.
When to schedule a consultation (even if it is not an emergency)
Agenda valuation yes:
- Shortness of breath is new or worsening
- Limits your daily activities
- Appears when you go to bed or wakes you up in the night
- Accompanied by palpitations, chest pain/pressure, leg swelling or marked tiredness
- You have risk factors (hypertension, diabetes, high cholesterol, smoking or family history).
You can learn about the cardiological check up o schedule an appointment.
References
- American Heart Association. Heart Failure Signs and Symptoms. See source
- NHS. Shortness of breath. See source
- Mayo Clinic. Shortness of breath. See source