Shortness of breath, also called dyspnea, is a feeling of uncomfortable breathing or a feeling that you cannot get enough air into your lungs. It can occur at rest or with exertion. Shortness of breath is a common symptom and can be caused by many medical conditions, some of which are serious like heart problems. However, not all cases of shortness of breath indicate an underlying heart condition. There are many potential causes of shortness of breath including lung diseases, respiratory infections, anxiety disorders, anemia, obesity, and more. This article will explore the connection between shortness of breath and heart problems and discuss when shortness of breath warrants medical evaluation.
What Causes Shortness of Breath?
Some common causes of shortness of breath include:
- Asthma – This chronic lung disease causes swelling and narrowing of the airways.
- Chronic obstructive pulmonary disease (COPD) – COPD is a progressive disease that blocks airflow and makes breathing difficult.
- Pneumonia – This lung infection causes inflammation that fills the air sacs with fluid.
- Pulmonary embolism – A blood clot in the lungs blocks blood flow and oxygen transport.
- Anemia – Low red blood cell count reduces oxygen delivery.
- Obesity – Excess weight presses on the diaphragm and chest wall.
- Anxiety disorders – Shortness of breath is a common symptom of panic attacks.
- Allergic reaction – Substances like pollen or food trigger swollen airways.
- Heart problems – Heart conditions like heart failure, coronary artery disease, heart valve disease, and arrhythmias can cause shortness of breath.
As you can see, shortness of breath has a wide range of potential underlying causes. Some originate in the respiratory system while others impair oxygen transport and delivery. Underlying heart conditions are just one contributing factor to shortness of breath.
How Do Heart Problems Cause Shortness of Breath?
Heart problems like coronary artery disease, heart failure, valve abnormalities, and arrhythmias can all lead to shortness of breath. Here are some specifics on how different heart conditions contribute to breathlessness:
Coronary Artery Disease
Coronary artery disease occurs when plaque builds up inside the heart’s arteries. This narrows the arteries and reduces blood flow to the heart muscle. The lack of oxygenated blood can cause shortness of breath, especially during physical activity when the heart works harder. Coronary artery spasms can also temporarily limit blood flow and oxygen, resulting in sudden onset shortness of breath.
Heart Failure
Heart failure means the heart muscle is damaged or weakened and cannot pump blood effectively. Fluid can back up into the lungs due to impaired pumping action. This pulmonary edema or fluid in the lungs makes it difficult to breathe and causes shortness of breath. Lying flat and physical activity tend to worsen the symptoms.
Abnormal Heart Valves
Defective heart valves that do not open fully or leak blood backward can impair normal blood flow. The inefficient circulation and oxygen delivery can manifest as shortness of breath.
Arrhythmias
Irregular heart rhythms like atrial fibrillation, ventricular tachycardia, and heart block disrupt the heart’s normal pumping function. The ineffective heart beat leads to impaired blood flow and oxygenation, potentially causing shortness of breath symptoms.
So in summary, different types of heart disease affect the heart’s pumping ability and circulation. oxygen delivery to the body’s tissues is reduced. This lack of oxygen produces air hunger and the sensation of shortness of breath.
Other Causes of Shortness of Breath
While heart problems are one potential cause of shortness of breath, there are many other medical conditions that can make you feel short of breath. Even athletes in peak physical condition can experience shortness of breath with intense training. Some other causes not related to the heart include:
- Lung diseases – Chronic conditions that affect the lungs directly such as asthma, COPD, pulmonary fibrosis, and cystic fibrosis can cause ongoing shortness of breath.
- Pneumonia – This lung infection inflames and fills the alveoli with fluid, impairing oxygen exchange.
- Pulmonary embolism – A large blood clot blocks an artery in the lungs.
- Anemia – Low red blood cell counts diminish oxygen carrying capacity.
- Obesity – Excess weight impairs lung expansion and diaphragm movement.
- Deconditioning – Being out of shape can make you short of breath with exertion.
- Allergies – Substances you are allergic to cause airway inflammation.
- Vocal cord dysfunction – The vocal cords inappropriately close when breathing in.
- Exposure to pollution and toxins – Particles you breathe in can damage airways.
As you can see from this list, there are numerous medical problems beyond heart conditions that could explain shortness of breath symptoms. Only a doctor can diagnose the exact cause in an individual patient.
When is Shortness of Breath an Emergency?
Most of the time, shortness of breath comes on gradually and improves with rest. However, in some circumstances, shortness of breath requires prompt medical attention. Here are some clues that shortness of breath may be a medical emergency:
- Onset is very sudden and severe
- Associated chest pain, palpitations, or loss of consciousness
- Associated coughing up blood
- Caused by an injury like a punctured lung
- After a traumatic accident
- Unable to speak in full sentences
- Blue lips or fingers
- Wheezing or high pitched noises when breathing
- Unrelieved by medications or inhalers if you have asthma or COPD
If you experience shortness of breath with any of the above features, seek medical care immediately. Call 911 or have someone drive you to an emergency room. Severe shortness of breath that comes on suddenly (called acute shortness of breath) can indicate a life-threatening underlying problem like a pulmonary embolism, pneumothorax, asthma attack, or heart attack. Prompt treatment is crucial.
When to See a Doctor for Shortness of Breath
Aside from emergent cases, you should also see a doctor to evaluate shortness of breath that:
- Occurs at rest or with minimal exertion
- Lasts longer than a week or two
- Is worsening over time
- Is accompanied by swelling, weight gain or fatigue
- Occurs without chest pain but you have risk factors for heart disease
- Is unrelieved by quick-acting inhalers if you have asthma
- Happens after a recent illness like pneumonia
Recurring or unexplained shortness of breath interferes with quality of life. Seek medical care to determine the underlying cause and appropriate treatment. Diagnostic tests like chest x-rays, CT scans, echocardiograms, and lab work help evaluate lung structure, heart function, blood counts, and more.
Is Shortness of Breath Always Related to Heart Problems?
No, shortness of breath is not always due to heart problems. While heart conditions are one potential cause, shortness of breath more commonly results from primary lung diseases. Studies have found the following breakdown of causes:
| Asthma – 35% |
| COPD – 25% |
| Congestive heart failure – 10% |
| Other heart problems – 5% |
| Obesity – 5% |
| Infection – 5% |
| Interstitial lung disease – 5% |
| Anemia – 3% |
| Anxiety – 2% |
| Unknown – 5% |
As shown, lung diseases account for about 60% of shortness of breath cases. Heart conditions like congestive heart failure and coronary artery disease make up around 15%. A fraction have no identifiable cause.
So in the majority people, shortness of breath stems from asthma, COPD, respiratory infections, and other non-cardiac causes. However, because heart disease can be a serious underlying problem, medical evaluation is still recommended for unexplained shortness of breath.
Is Shortness of Breath Always Serious?
Shortness of breath is always abnormal and warrants paying attention. However, it is not always a sign of serious illness. In many cases, shortness of breath can result from minor, treatable problems:
- Out of shape
- Mild anemia
- Obesity
- Allergies
- Common cold
- Vocal cord dysfunction
- Pregnancy
- Stress and anxiety
With treatment of the underlying cause, mild shortness of breath may resolve quickly. Examples of treatment options include:
- Exercise training program
- Iron supplements
- Weight loss
- Allergy medications
- Humidifier for congestion
- Speech therapy for vocal cords
- Stress management
However, shortness of breath should never be ignored. Without evaluation, seemingly minor shortness of breath could overlook a serious problem like heart failure, blood clots, or lung cancer. Any unexplained shortness of breath warrants medical assessment.
How is Shortness of Breath Evaluated?
To get to the bottom of shortness of breath, doctors use:
- Medical history – Details about symptoms, onset, relieving/aggravating factors. Also medical conditions, medications, and family history.
- Physical exam – Listen to the chest with a stethoscope, feel for enlarged organs, check vital signs, assess for swelling.
- Pulse oximetry – A finger sensor gauges oxygen saturation level in the blood.
- Blood tests – Evaluate blood cell counts, electrolytes, kidney and liver enzymes, D-dimer, BNP.
- Imaging – Chest X-ray, CT scan, echocardiogram to visualize the heart and lungs.
- Spirometry – Blowing into a tube measures lung capacity and airflow.
- Exercise stress test – Monitors EKG, blood pressure, and oxygen saturation with exertion.
These tests help identify or rule out potential causes so appropriate treatment can be initiated.
Treatment Options for Shortness of Breath
Treatment depends on the underlying cause but may include:
- Bronchodilators open airways for lung diseases
- Inhaled steroids decrease lung inflammation
- Antibiotics treat respiratory infections
- Diuretics eliminate excess fluid in heart failure
- Supplemental oxygen for hypoxemia
- Treating arrhythmias can improve heart function
- CPAP for obstructive sleep apnea
- Pulmonary rehabilitation programs
For shortness of breath related to anxiety, counseling, relaxation techniques, and medications to reduce anxiety may help.
Regardless of cause, breathing control techniques can provide symptomatic relief. Pursed lip breathing maximizes inhales and slows exhales. Positional strategies like leaning over a counter During episodes of shortness of breath can also help.
Prevention of Shortness of Breath
You may be able to reduce shortness of breath episodes by:
- Quitting smoking
- Losing excess weight
- Building cardiovascular endurance with regular exercise
- Using inhalers as prescribed if you have asthma
- Getting vaccinated like the flu shot and pneumonia vaccine
- Managing heart disease risk factors – diabetes, high BP, high cholesterol
Avoiding triggers of shortness of breath like altitude, hot humid weather, and allergens can also help in susceptible people.
Conclusion
Shortness of breath has a wide range of potential causes, including lung diseases, respiratory infections, obesity, deconditioning, anxiety, anemia, and heart problems. About 15% of cases are due to underlying heart conditions. While heart disease is one possible cause, shortness of breath more often stems from asthma, COPD, and other lung problems. Still, unexplained shortness of breath warrants medical evaluation to identify or rule out serious conditions like heart failure or pulmonary embolism. Treatment targets the specific cause. Breathing control techniques can provide symptomatic relief. With prompt diagnosis and correct treatment, shortness of breath can often be managed effectively.