| Coastal Pulmonary Medicine,
P.A. Shortness of breath (dyspnea) is a common
symptom prompting visits to physician’s
offices and the emergency department. Furthermore
it can also be an important presenting sign of
several serious medical problems. Shortness of
breath can be the first manifestation of lung
and heart disease. It is also commonly seen in
patients with anemia, liver or kidney disease,
and in some patients with neuromuscular problems.
Very frequently, however, dyspnea is simply the
result of being out of shape or deconditioned.
So, how can a physician tell if shortness of
breath is the result of a serious problem? First,
one has to take into account all of the patient’s
past medical history. Certainly, if a patient
has a history of cardiac disease, the initial
evaluation will focus on the heart. Similarly,
one will be more likely to suspect a primary lung
problem in a patient with a history of heavy smoking.
Patients with disorders like lupus, rheumatoid
arthritis and scleroderma are at risk for developing
pulmonary fibrosis or “scarring of the lungs”.
However, a good physician will keep an open mind
and consider all possibilities.
Second, doctors will ask about any other associated
symptoms. Cough, sputum production, and wheezing
raise concern for airways diseases such as asthma
or chronic obstructive pulmonary disease (COPD).
Shortness of breath when lying flat and/or the
presence of swelling of the ankles point toward
congestive heart failure and other cardiac problems.
Chest pain and coughing up blood are frequent
symptoms of a potentially deadly disorder of clots
passing into the blood vessels of the lung (pulmonary
emboli). Patients should be sure to describe all
of their symptoms to their doctor.
Next, the doctor will perform a detailed physical
exam and likely perform some initial tests. A
blood oxygen level will be checked from a finger
using a device called an oximeter. A chest x-ray
is essential and will help differentiate between
various problems such as heart failure, emphysema,
and fibrosis, among many others. An electrocardiogram
(EKG) is also frequently ordered to further evaluate
the heart. Blood work to check for anemia, liver
or kidney disease will often be sent. More recently,
a blood test called a BNP level has become available
and is very helpful in diagnosing heart failure.
If a patient is referred to a lung disease specialist
(pulmonologist), pulmonary function tests will
be performed to measure airways function and lung
volumes. We can also assess the lung’s ability
to transfer oxygen to the blood stream. A cardiopulmonary
exercise test is occasionally used to differentiate
between cardiac disease, lung disorders, and deconditioning
in difficult to diagnose cases.
In summary, shortness of breath is a very common
symptom of a number of potentially serious disorders
and should not be ignored. Do not hesitate to
consult your physician for this complaint.
Brian M. Legere, M.D., F.C.C.P.
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