Healthcare

BREATHING DIFFICULTIES (SHORTNESS OF BREATH) Part II 

As discussed in Part I of this article, shortness of breath (SOB) is the perception of additional effort to breathe. It is described variably by people, depending on how they feel. If you recollect from the previous article, the lungs and the heart are the two major organs in the body involved with breathing. The lungs are where oxygen exchange occurs. The heart on the other hand, pumps blood throughout the body so all tissues can get oxygenated blood. This article will focus on heart related causes of SOB. To benefit from this article, it is important you read the previous one.

 Causes of SOB

Coronary artery disease (CAD): CAD occurs when the blood supply to a part of the heart is interrupted more often than not by plaques (deposits in the blood vessel walls containing cholesterol). This narrowing of the blood vessels supplying the heart (coronary artery) results in chest pain and SOB. It may present as recurrent episodes of chest pain, along with SOB. If the blockage of the vessel involves a large area of the heart, it may cause severe chest pain, acute SOB and if care is not taken, death may occur. SOB along with chest pain is an extreme emergency.

Symptoms of CAD include chest pain (often pressure like), which may or may not be associated with sweating, dizziness, lightheadedness and changes in heart beat.

 Heart failure

Heart failure (HF) occurs when the heart cannot pump blood as it should normally. Many diseases can lead to heart failure include: CAD, high blood pressure, diabetes, chronic lung disease, and severe anemia (low blood level). If blood is not pumped into the lungs at a normal rate and volume, not all the blood will get enough of the required oxygen. As a result, the person will feel short of breath. Generally, people with heart failure become short of breath over a period of time. However, if the cause of heart failure is sudden, SOB may occur very quickly.

Symptoms of heart failure include: tiredness, reduced exercise capacity, swelling of the feet (edema), SOB and difficulty lying flat in bed without SOB (orthopnea).

 Anemia (Low blood level)

Blood is the transport medium of oxygen to tissues. When blood level is low, there will not be enough cells to carry the oxygen to the tissues. With reduced oxygen levels anemics become tired over a period of time. Their ability to cope with their usual activities decreases as their blood level drops. As anemia worsens, they are fatigued, have faster heart rate (palpitations), dizziness/lightheadedness and in severe cases, swelling of the feet as heart failure occurs.

 Anxiety Disorder (Panic Attacks)

When people are anxious, their heart and breathing rates may increase. In severe cases of anxiety, some people have SOB, and/or may feel like they are choking or about to pass out. Do not assume you are having panic attacks if you never had such history or if you have other medical problems. It is better to be safe than sorry. Seek medical help.

  Questions & Answers

Q: I am an asthmatic. Sometimes I feel SOB that feels different from my usual asthma attack. Can I just assume my asthma is changing pattern?

A: Asthmatics must be very careful. Not all wheezing is asthma. If you feel SOB, and it does not respond to your pumps, seek medical attention. If the SOB is different from your usual asthma pattern, especially if associated with any other symptoms, call 911.

 

Q: I had a history of panic attacks at a younger age. I smoke and I have been told I have high cholesterol. Is it okay to assume that any SOB is my panic attack?

A: Smoking and high cholesterol are risk factors for CAD. Do not assume you are still having panic attacks. It may be more than that now. Seek medical help.

 

Q: I do not smoke but my spouse does. Lately I have been feeling I need extra effort to breathe. Since I did not smoke directly do I need to worry?

A: You are what we call a second-hand smoker. Your SOB still needs to be investigated.

  Take Home Message

Not all wheezing is asthma-related. Do not delay in seeking medical attention for someone who wheezes.

SOB can be investigated and treated. The initial tests for making diagnosis are non-invasive. It could be as simple as a lung function test, ultrasound of the heart (Echocardiogram) or another blood test. The doctor may have to do special tests if the cause cannot be determined with a simple test. With earlier diagnosis of SOB, the eventual outcome may be better. Delay in diagnosis can be life-threatening.

Smoking cessation has great impact on reducing the progression of lung diseases associated with SOB and whatever the cause of SOB, smoking will make it worse.

 

Dr. Oluwatoyosi Dairo can reached at Amazing Medical Services at 110-16 Sutphin Blvd., Jamaica NY 11435 or by phone at 718-526-7600.

Disclaimer: This column is not intended to substitute the care/advice of your doctor.