Dyspnoea (shortness of breath)

Feeling out of breath after climbing 4 flights of stairs at speed is normal. Feeling out of breath after walking to the bathroom is not. The pattern — when it happens, how quickly it came on, what it's associated with — tells most of the story.

Common causes

• Heart failure — fluid in the lungs because the heart isn't pumping efficiently. Worse on lying flat (orthopnoea), often with ankle swelling. Causes: long-standing untreated BP, post-heart-attack, valve disease.
• Coronary artery disease — breathlessness on exertion can be the only symptom of significant blockages, especially in diabetics and women.
• Asthma / COPD — wheezing, worse with allergens or cold air or exertion. Often a long history.
• Pneumonia — breathlessness with fever, cough, sometimes chest pain.
• Pulmonary embolism — sudden severe breathlessness, often with chest pain. Emergency.
• Anaemia — low haemoglobin makes the heart work harder; breathlessness on mild exertion + fatigue + pallor.
• CKD — fluid overload from poor kidney function.
• Anxiety — feeling unable to take a deep breath, usually with other anxiety symptoms.

What we look for

History: how long has it been going on, can you climb one flight of stairs, can you lie flat at night, any ankle swelling, any chest pain, any wheeze. Examination: oxygen saturation (a single reading), heart rate, respiratory rate, chest examination for crackles or wheeze, ankle swelling. Tests in the OPD: ECG, chest X-ray, CBC, basic blood tests, sometimes ECHO and PFT (pulmonary function test).

What to do

For new breathlessness, especially if it has come on over days to weeks, please don't put it off. Heart failure in particular responds well to treatment when caught early.