Shortness of Breath: Possible Causes and When to Be Seen

What it involves

MedlinePlus describes breathing difficulty as difficult or uncomfortable breathing, or a feeling that you are not getting enough air. It says there is no standard definition and that it is a subjective feeling, so only the person feeling it can decide if it is present. Shortness of breath has many different causes, among them problems with the lungs, the airways, and the heart.

Who this is for

• Patients who get winded with activity that did not bother them before
• Patients with wheezing, a lingering cough, or tightness in the chest
• Patients with heart, lung, or blood conditions who notice a change in their breathing
• Patients who are unsure whether their symptoms are an emergency or can be handled with a visit

What to expect

• Questions about when it started, what makes it worse, and whether you wheeze or make grunting sounds
• A physical exam, listening to your heart and lungs, and checking your oxygen level
• A look at your medicines and any existing heart, lung, or blood conditions
• A decision on tests, such as blood work or an EKG, or a referral for imaging and lung function tests

Call 911 first in these cases

MedlinePlus says to go to the emergency room or call the local emergency number if breathing difficulty comes on suddenly, seriously interferes with your breathing and even talking, or if someone completely stops breathing. Chest pain with breathlessness is covered in the chest pain guide. Waiting for a routine appointment is the wrong choice for any of these. Everything below applies to breathing difficulty that you can talk through and are able to describe. Wheezing or tightness in the throat together with hives can signal a serious allergic reaction, and the hives guide lists the signs that mean call 911.

Symptoms that should prompt a call or visit

MedlinePlus says to see your provider if breathing difficulty comes with any of these:

• Chest discomfort, pain, or pressure
• Fever, wheezing, or throat tightness with a barking cough
• Shortness of breath after only slight activity or while at rest
• Shortness of breath that wakes you at night or makes you sleep propped up
• Shortness of breath with simple talking, or significant worsening of a baseline problem

The heart and lung causes

MedlinePlus lists lung causes such as pneumonia, COPD, a blood clot in the lungs, and high blood pressure in the lung arteries. Heart causes include angina, heart attack, heart failure, and heart rhythm disturbances. A heart that cannot pump enough blood can cause breathlessness because the brain, muscles, and organs do not get enough oxygen. The heart failure management page and the heart palpitations evaluation describe the heart side. Breathlessness that gets worse with activity during a chest cold is one of the symptoms listed in the acute bronchitis guide, along with how bronchitis differs from pneumonia.

Causes outside the heart and lungs

MedlinePlus also lists allergies, high altitude, dust, emotional distress such as anxiety, panic attacks, obesity, hiatal hernia, anemia, and weakness of the breathing muscles. Anemia is worth knowing about because it is common and checked with a simple blood test, as the anemia and low iron guide explains. MedlinePlus also notes that mild breathing difficulty can be normal, such as with a very stuffy nose or strenuous exercise you do not often do.

What a visit usually covers

MedlinePlus says a provider will examine you and ask about your medical history and symptoms, including how long you have had difficulty and when it started. Tests that may be ordered include pulse oximetry to check your blood oxygen, blood tests, a chest x-ray, a CT scan, an electrocardiogram, an echocardiogram, exercise testing, and lung function tests. At Serenity, the EKG is part of the EKG and heart screening page, while imaging and lung function tests are typically arranged through a referral.

Swelling, weight and breathlessness together

Breathlessness that comes with swollen ankles, weight gain over a few days, or a cough when lying down is a different conversation from breathlessness after a hard walk, and it is worth saying so on the phone when you book. The leg swelling evaluation and the persistent cough guide describe those patterns, and the obesity and BMI guide covers one common contributing factor.

Sources

• MedlinePlus — Breathing difficulty
• MedlinePlus — Breathing Problems