What does shortness of breath on exertion mean

To diagnose pulmonary arterial hypertension or certain interstitial lung diseases, right heart catheterization or bronchoscopy may be needed. Chronic dyspnea has been defined as shortness of breath lasting longer than one month. Enlarge Print. Electrocardiography and measurement of brain natriuretic peptide levels should be ordered if heart failure is suspected.

In patients with dyspnea, spirometry should be performed to diagnose airflow obstruction. Measurement of maximal inspiratory and expiratory pressures should be done when neuromuscular causes of dyspnea are suspected. In chronic dyspnea likely due to diffuse pulmonary disease, when the diagnosis is unclear, high-resolution noncontrast computed tomography of the chest should be performed. Patients with chronic dyspnea present with stable, but not necessarily normal, vital signs.

In addition to a history and physical examination, several diagnostic tests have been shown to be valuable in clarifying the underlying problem and planning appropriate treatment. Chemoreceptors in the brain and vascular system, mechanoreceptors in the chest wall and diaphragm, and pulmonary vagal receptors are thought to regulate breathing.

Cortical cerebral pathways allow conscious appraisal of the chemical environment and the mechanical status of the lungs. Dissociation between the motor command and the mechanical response of the respiratory system may produce a sensation of respiratory discomfort.

The perception of dyspnea derives from multiple physiologic and environmental factors, and may induce secondary physiologic and behavioral responses. Psychogenic dyspnea may be an acute presentation or a background symptom in generalized anxiety disorder. Dyspnea may be of neurogenic, respiratory, or cardiac origin, and may be associated with conditions such as anemia, deconditioning, or anxiety.

Drugs e. Amyotrophic lateral sclerosis, muscular dystrophies, phrenic nerve palsy, poliomyelitis. Asthma, congestive heart failure and myocardial ischemia, COPD, interstitial lung disease, pneumonia, and psychogenic disorders account for approximately 85 percent of all cases of shortness of breath.

The etiology of chronic dyspnea is multifactorial in up to one-third of patients. Exertional dyspnea, dry cough, malignancy, prescription or illicit drug use, chemical exposures. Tobacco use, cough, relief with bronchodilator, increased sputum production, hemoptysis and weight loss with malignancy. Wheezing, barrel chest, decreased breath sounds, accessory muscle use, clubbing, paradoxical pulse.

Wheezing, lower extremity swelling, pleural rub, prominent P 2 , murmur, right ventricular heave, JVD. Dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, chest pain or tightness, prior coronary artery disease or atrial fibrillation.

Edema, JVD, S 3 , displaced cardiac apical impulse, hepatojugular reflex, murmur, crackles, wheezing, tachycardia, S 4. ECG, brain natriuretic peptide, echocardiography, stress testing, coronary angiography.

To clarify dyspnea, the patient history should address the onset, character, duration, severity, periodicity, and progression of symptoms. Aggravating and ameliorating factors also should be noted. Patients with heart failure may have air hunger or a suffocating sensation, and those with asthma often describe a sensation of chest tightness.

Airway obstruction, including COPD, should be suspected in patients who are short of breath with cough or with increased sputum production, especially those with a history of smoking.

Wheezing also is a common symptom in patients with airway obstruction 10 but, like cough, may be present in those with asthma or heart failure. Patients may have advanced airflow limitation but only mild dyspnea. Standard inventories to determine the association between level of activity and dyspnea are available.

Predicting risk of airflow obstruction in primary care: validation of the lung function questionnaire LFQ. Respir Med. Patients with intermittent symptoms may be experiencing episodes of reflux and aspiration, or recurrent pulmonary emboli.

Heart failure may be variable and progressive over time. COPD, pulmonary hypertension, interstitial lung diseases, and neuromuscular disorders typically are insidious.

Fever may be associated with infectious, inflammatory, or neoplastic processes. Postprandial or recumbent dyspnea may indicate gastroesophageal reflux disease or aspiration. Patients with chronic pulmonary disease often are limited in their activities by respiratory discomfort. The absence of aggravation of dyspnea by exercise should prompt consideration of functional causes. Use of beta blockers may aggravate asthma. Amiodarone and methotrexate are associated with interstitial toxicity and pulmonary fibrosis.

Immobility, prolonged travel, or malignancy may suggest thromboembolic disease, which can result in progressive pulmonary hypertension. Response to treatments such as afterload reduction, diuretics, or bronchodilators can provide clues to the underlying disease process. Initial appearance, weight, vital signs, peak flow, and pulse oximetry provide important suggestions of underlying physiology.

Paradoxical pulse exaggerated variation in blood pressure with respiration may suggest COPD, asthma, or pericardial disease. Initial clinical judgment is helpful in diagnosing heart failure when COPD is present. Jugular venous distention in a setting of dyspnea suggests congestive heart failure.

The dominant examination finding in patients with bronchiectasis is pulmonary crackles or rales, generally bibasilar. Decreased heart sounds may be caused by pulmonary hyperexpansion, obesity, or cardiac tamponade. A pleural rub often indicates a pleural effusion. Hepatomegaly, ascites, hepatojugular reflux, or edema can be caused by right-sided heart failure or pulmonary hypertension.

The presence of clubbing should prompt evaluation to exclude lung cancer, bronchiectasis, or idiopathic pulmonary fibrosis. Rochester, Minn. Dyspnea pediatric. Mahler DA, et al. Recent advances in dyspnea. Walls RM, et al. Philadelphia, Pa. Accessed March 15, Merck Manual Professional Version.

Shortness of breath. American Cancer Society. Mahler DA. Evaluation of dyspnea in the elderly. Clinics in Geriatric Medicine. Davis C, et al. Advances in the prevention and treatment of high altitude illness. Emergency Medicine Clinics of North America. Warning signs of heart failure. American Heart Association.

Accessed March 18, National Heart, Lung, and Blood Institute. Warning signs of a heart attack. Venous thromboembolism. Treating shortness of breath.

How to recognize a potential medical emergency. Read this next. Medically reviewed by Gerhard Whitworth, R. Medically reviewed by Raj Dasgupta, MD. Medically reviewed by Deborah Weatherspoon, Ph. Medically reviewed by Dr. Payal Kohli, M. Exercise Stress Test. Medically reviewed by Alana Biggers, M. Learn about the causes…. Dyspnea is the term used when someone experiences a shortness of breath.

There are numerous causes including simply being out of shpae, being at high…. Paroxysmal nocturnal dyspnea is a condition that causes a person to experience a sudden shortness of breath during sleep. Learn more about the…. Some potential causes of shortness of breath when lying down include heart failure, obesity, and emphysema. Learn more about the causes of shortness…. What causes shortness of breath, and is this issue treatable at home?

In this article, learn about some home remedies that may help manage shortness…. Definition Cause for concern? Why it happens Underlying conditions Contacting a doctor Summary Dyspnea, or shortness of breath, that occurs during exertion has several possible causes. What is it? Is it a cause for concern? Why does it happen? What underlying conditions cause it? When to contact a doctor.

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