Shortness of Breath (Dysnea)

Common causes shortness of breath:

1. Heart causes

• Leaky heart valves
• Fluid in lungs
• Holes between heart chambers
• Ischemic heart disease

2. Brain (psychological)

• Stress/anxiety

3. Lungs (pulmonary)

• Asthma
• Emphysema
• Blood clots in lungs (pulmonary embolism)
• High blood pressure in lungs (pulmonary hypertension)

4. Other Causes

• Out of shape
• Rapid weight gain
• Anemia

In order to find the cause of your shortness of breath, your doctor will start by asking you questions about your medical history and, then, will do a physical examination.

Next, your doctor will check the amount of oxygen in your blood. This is a simple test done by placing a sensor on your finger or earlobe while you are sitting and walking. Once those tests are done, your doctor may then perform one or more of the following screening tests:

•Chest x-ray: to look at the lungs.

• Breathing tests (called pulmonary function tests): to see how well the lungs get air in and out.

• Blood tests: to check for anemia or low blood count.

• Heart tracing (called an electrocardiogram or ECG): to see if there is any heart damage.

• CT scan of the chest: shows more detail than a chest  x-ray and may show scarring in the lungs (interstitial lung disease). Sometimes CT scans are done with contrast. This means a dye is injected into a vein to give an even more detailed view. This may be done if your doctor thinks there may be a blood clot in your lungs.

• If your doctor suspects you may have asthma, you may be given a medication that affects the bronchial tubes while breathing tests are done.

• Bronchoscopy: If the breathing tests show that something is blocking your airway, your doctor may need to look into your airways with a lighted scope. This procedure is called a bronchoscopy. This test may also be necessary, along with a biopsy of the lung, if the CT scan shows areas which are not normal.

• Muscle and nerve testing: to see if your muscles or nerves are causing weak breathing muscles (this is rare).

• Heart tests: many times, shortness of breath is not caused by a lung problem but by a heart problem instead. The most common heart tests for patients with shortness of breath include:

1. echocardiogram—ultrasound waves are used to get a detailed look at the heart valves and how well the heart pumps.
2. stress test—walking on a treadmill to check the heart during exercise.
3. nuclear medicine testing—another way to get a look at how well the heart is working.
4. cardiopulmonary exercise test. This means exercising on a treadmill or bicycle until you cannot go any further. This test helps your doctor see how well your whole body is working during activity.

The heart tests help your doctor to identify problems, such as the following:

• Leaky heart valves.
• Stiff heart muscles (diastolic dysfunction).
• Heart muscles that do not get enough blood during exercise (ischemic heart disease).
• An opening in the heart that should not be there (patent foramen ovale or atrial septal defect). This condition makes it difficult for the lungs to get enough oxygen into the blood.
• A connection between veins and arteries in the lungs or somewhere else in the body that should not be there (arteriovenous malformation or AVM).
• High pressure on the right side of the heart. This can be from a lung problem or from blood clots or other blockages in the lungs (chronic pulmonary embolism or pulmonary vasculitis). High pressures in the right side of the heart can also be from an unknown cause (primary pulmonary hypertension).

Shortness of breath should not be ignored. Since it has many causes, it may take awhile for your doctor to find the exact reason for your breathing trouble. You may even need to repeat certain tests. Once a cause has been determined, your doctor will talk to you about how best to treat your condition.