What are the common causes of shortness of breath on exertion. How is shortness of breath on exertion diagnosed. What are the warning signs of a medical emergency related to breathlessness. How can cardiopulmonary exercise testing help diagnose unusual causes of breathlessness and fatigue.

Understanding Shortness of Breath on Exertion

Shortness of breath on exertion, also known as exertional dyspnea or SOBOE, is a condition characterized by difficulty breathing during simple activities like climbing stairs or walking to the mailbox. This symptom manifests differently for each individual but typically involves a sensation of not being able to catch one’s breath.

Normal breathing is typically slow and effortless. When breathing becomes rapid and shallow, it indicates shortness of breath. Some people may switch from nasal to mouth breathing in an attempt to get more air. While it’s normal to experience breathlessness during intense physical activity, especially for those unaccustomed to exercise, sudden onset of breathing difficulties during routine activities may signal a medical emergency.

Common Causes of Shortness of Breath on Exertion

Shortness of breath on exertion can be attributed to various physical and psychological factors. It may even result from poor environmental conditions. Some common causes include:

• Chronic obstructive pulmonary disease (COPD)
• Congestive heart failure
• Asthma
• Poor physical conditioning
• Late-stage pregnancy
• Anemia
• Pneumonia
• Pulmonary embolism
• Interstitial lung disease
• Cancer
• Obesity
• Kidney disease
• Liver disease

Diagnosing Shortness of Breath on Exertion

If you experience shortness of breath on exertion, it’s crucial to consult a healthcare professional. The diagnostic process typically involves:

1. A thorough medical history review
2. Physical examination
3. Chest X-ray
4. Chest CT scan
5. Exercise testing
6. Pulmonary function studies (spirometry)
7. Laboratory tests, including blood work

The results of these tests help determine the underlying cause of breathlessness, guiding the appropriate treatment approach.

Treatment Approaches for Shortness of Breath on Exertion

Treatment for shortness of breath on exertion varies depending on the underlying cause. For instance, asthma-related breathlessness may be managed with inhalers, while poor physical conditioning might require a tailored fitness program. In some cases, such as pregnancy-related breathlessness, the symptom may resolve on its own after childbirth.

Can shortness of breath on exertion be a medical emergency?

Yes, sudden onset of shortness of breath can indeed be a medical emergency. It’s crucial to seek immediate medical attention if the breathlessness is accompanied by symptoms such as:

• Air hunger (feeling of not getting enough air despite deep breathing)
• Gasping for breath
• Choking sensation
• Chest pain
• Confusion
• Fainting or loss of consciousness
• Profuse sweating
• Pale or bluish skin (cyanosis)
• Dizziness
• Coughing up blood or pinkish, frothy mucus

The Role of Cardiopulmonary Exercise Testing in Diagnosing Breathlessness

In some cases, routine tests may not fully explain the nature or severity of a person’s breathlessness and fatigue. This is where cardiopulmonary exercise testing (CPET) can play a crucial role in unmasking unusual causes of these symptoms.

What is cardiopulmonary exercise testing?

Cardiopulmonary exercise testing (CPET) is an advanced diagnostic tool that provides comprehensive information about both heart and lung function during exercise. Unlike a standard exercise stress test, which only monitors heart rate, rhythm, and blood pressure, CPET collects additional data to assess how the body responds to physical exertion.

During a CPET, patients wear a small mask or mouthpiece connected to a device that measures the volume of air inhaled and exhaled, as well as the concentrations of oxygen and carbon dioxide in the breath. This allows for a detailed analysis of the body’s respiratory and cardiovascular performance under stress.

Benefits of Cardiopulmonary Exercise Testing

CPET offers several advantages in diagnosing and understanding breathlessness and fatigue:

1. Comprehensive assessment: CPET provides a holistic view of how the heart, lungs, and muscles work together during exercise.
2. Identification of subtle abnormalities: It can detect issues that may not be apparent in resting tests or standard stress tests.
3. Differentiation between causes: CPET helps distinguish between cardiac, pulmonary, and muscular causes of breathlessness.
4. Evaluation of exercise capacity: It objectively measures a person’s fitness level and exercise tolerance.
5. Guidance for treatment: The results can inform personalized treatment plans and exercise prescriptions.

Unusual Causes of Breathlessness Revealed by CPET

Cardiopulmonary exercise testing can uncover less common reasons for shortness of breath and fatigue, including:

• Mitochondrial myopathy: A condition affecting the energy-producing structures in cells
• Preload failure: Inadequate blood return to the heart during exercise
• Pulmonary arterial hypertension: High blood pressure in the arteries of the lungs
• Chronic thromboembolic pulmonary hypertension: A rare form of high blood pressure in the lungs caused by old blood clots
• Deconditioning: Significant loss of fitness due to inactivity

CPET and Long COVID

Cardiopulmonary exercise testing has also emerged as a valuable tool in understanding and diagnosing long COVID, a condition characterized by persistent symptoms following COVID-19 infection. CPET can help identify specific physiological abnormalities in long COVID patients, such as:

• Reduced oxygen extraction by muscles
• Autonomic dysfunction
• Hyperventilation
• Circulatory impairment

These findings can guide targeted treatments and rehabilitation strategies for individuals suffering from long COVID symptoms.

How does CPET contribute to long COVID research?

CPET provides objective data on the physiological changes occurring in long COVID patients during exercise. This information helps researchers better understand the mechanisms underlying persistent symptoms and develop more effective treatments. Additionally, CPET can be used to track improvements in patients’ conditions over time and assess the effectiveness of various interventions.

Limitations and Considerations of CPET

While cardiopulmonary exercise testing is a powerful diagnostic tool, it’s important to consider its limitations:

• Availability: CPET is not widely available and is typically performed at specialized centers.
• Expertise required: Interpreting CPET results requires specialized knowledge and experience.
• Cost: CPET can be more expensive than standard stress tests.
• Time-consuming: The test and analysis process can take several hours.
• Physical demands: Some patients may not be able to complete the test due to severe symptoms or physical limitations.

Who should consider undergoing CPET?

Cardiopulmonary exercise testing may be recommended for individuals who:

• Experience unexplained shortness of breath or fatigue
• Have normal results on standard tests despite significant symptoms
• Suffer from complex or multiple medical conditions affecting exercise tolerance
• Are being evaluated for certain surgical procedures, such as lung transplantation
• Are athletes or highly active individuals seeking to optimize their performance
• Have persistent symptoms following COVID-19 infection (long COVID)

Future Directions in Breathlessness Diagnosis and Management

As our understanding of breathlessness and fatigue continues to evolve, several promising areas of research and development are emerging:

1. Advanced imaging techniques: New imaging modalities may provide additional insights into lung and heart function during exercise.
2. Wearable technology: Continuous monitoring devices could offer real-time data on respiratory and cardiovascular parameters in daily life.
3. Artificial intelligence: Machine learning algorithms may help identify subtle patterns in CPET data, improving diagnostic accuracy.
4. Personalized medicine: Genetic and molecular profiling could lead to more targeted treatments for breathlessness and fatigue.
5. Telemedicine applications: Remote monitoring and virtual CPET protocols may increase accessibility to specialized diagnostic services.

How might these advancements impact patient care?

These developments have the potential to revolutionize the diagnosis and management of breathlessness and fatigue. Earlier and more accurate identification of underlying causes could lead to more effective treatments, improved quality of life for patients, and reduced healthcare costs. Additionally, personalized approaches based on individual physiology and genetics may result in more tailored and successful interventions.

As research progresses, it’s crucial for healthcare providers to stay informed about the latest diagnostic tools and treatment options. Patients experiencing persistent breathlessness or fatigue should work closely with their healthcare team to explore all available options, including advanced testing like CPET when appropriate.

By combining thorough clinical evaluation, advanced diagnostic techniques, and personalized treatment approaches, we can continue to improve outcomes for individuals suffering from shortness of breath on exertion and related symptoms. As our understanding deepens, we move closer to unraveling the complex interplay of factors contributing to these common yet often challenging health concerns.

Shortness of Breath on Exertion

What is shortness of breath on exertion?

“Shortness of breath on exertion” is a term used to describe difficulty breathing when engaged in a simple activity like walking up a flight of stairs or going to the mailbox.

It’s also known as:

• SOBOE
• breathlessness on exertion
• exertional dyspnea
• dyspnea on effort
• exertional breathlessness
• short of breath with activity
• dyspnea on exertion (DOE)

While each person experiences this symptom differently, it’s usually marked by feeling like you can’t catch your breath.

Normal breathing is relatively slow and occurs without much thought.

When you begin breathing faster and feel that the breath is shallower, that’s what shortness of breath feels like. You may switch from breathing through your nose to your mouth to try to get more air. When this happens without athletic exertion, it’s a concern.

Many people feel short of breath during strenuous activity if they aren’t accustomed to exercise.

But if you have a sudden onset of difficulty breathing doing routine day-to-day activities, it may be a medical emergency.

Shortness of breath on exertion is a sign that your lungs aren’t getting enough oxygen in or not getting enough carbon dioxide out. It can be a warning sign of something serious.

Shortness of breath occurs as a result of the interaction of many physical and even psychological factors. A panic attack, for instance, is something triggered by the brain but with very real, physical symptoms. It could even be the result of environmental conditions if air quality is poor in your area.

All of the following can be connected to shortness of breath on exertion:

• chronic obstructive pulmonary disease (COPD)
• congestive heart failure
• asthma
• poor physical conditioning
• late-stage pregnancy
• anemia
• pneumonia
• pulmonary embolism
• lung disease (interstitial fibrosis)
• cancer tumor
• obesity
• kidney disease
• liver disease

When you have shortness of breath on exertion, you should make an appointment to see your doctor. They will ask about your medical history and conduct an exam.

Tests will help determine the cause of your breathlessness. These tests may include:

• chest X-ray
• chest CT scan
• exercise testing
• pulmonary function studies (spirometry)
• lab tests, including a blood test

Treatment for this condition will depend on the findings of the medical tests. Management will focus on treating the cause of the shortness of breath.

For instance, if it’s caused by asthma, your doctor may recommend you use an inhaler. If it’s a sign of poor physical condition, your doctor will likely suggest a fitness program.

You may simply have to cope with the symptom until the cause is resolved. In pregnancy, for instance, your breathlessness should improve after the baby is born.

A sudden onset of shortness of breath could be a medical emergency. Call 911 immediately if you or someone you know experiences this, especially if it’s accompanied by the following:

• air hunger (the feeling that no matter how deep you breathe, you still aren’t getting enough air)
• gasping for breath
• choking
• chest pain
• confusion
• passing out or fainting
• sweating profusely
• pallor (pale skin)
• cyanosis (bluish-colored skin)
• dizziness
• coughing up blood or bubbly, pinkish mucus

Unmasking the varied causes of breathlessness and fatigue

Cardiopulmonary exercise testing can help reveal unusual reasons for these common symptoms — and also shed light on long COVID.

One of the vexing things about certain common health complaints is the range of possible underlying causes. For example, feeling short of breath is perfectly normal after a burst of vigorous exercise. But for some people, even mild exertion can trigger a sensation of breathlessness, or what doctors call dyspnea. It’s often accompanied by symptoms such as fatigue and lightheadedness.

Most of the time, heart or lung issues are to blame. In many cases, routine tests — including a chest x-ray, echocardiogram (heart ultrasound), lung function tests, and blood tests — can uncover the underlying reason for a person’s breathlessness.

“But sometimes, all the results are perfectly normal, or the findings don’t fully explain the nature or severity of the person’s symptoms,” says Dr. David Systrom, who directs the Dyspnea Clinic at Harvard-affiliated Brigham and Women’s Hospital. That’s where cardio­pulmonary exercise testing (CPET) can play a role (see “What is cardiopulmonary exercise testing?”).

Unusual causes

At one time, about half of the people referred to the Dyspnea Clinic who underwent CPET were found to have pulmonary hypertension (an uncommon condition in which the arteries to the lungs become thick and stiff) or heart failure with preserved ejection fraction (a form of heart failure resulting from stiffness in the heart’s lower left chamber). “But about five years ago, we also started seeing more patients with chronic fatigue syndrome,” says Dr. Systrom. Officially known as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), this complex disease involves abnormalities in many organ systems, most notably the nervous and vascular systems.

The COVID connection

Many people with ME/CFS have unusual circulation problems that happen because the peripheral nervous system fails to signal the large veins in the legs, pelvis, and abdomen to constrict and deliver blood back up to the heart. This leads to what doctors call pre-load insufficiency, which means the heart’s upper right chamber (atrium) doesn’t fill up and reach a normal pressure before each beat. This problem is not only ubiquitous in people with ME/CFS but also extremely common in people with a condition known as long COVID, says Dr. Systrom.

Most people who get COVID-19 recover within weeks or a few months. But some experience lingering fatigue, lightheadedness, palpitations, brain fog, and breathlessness, which is often described as long COVID. Experts now refer to this long-lasting illness as PASC, which stands for post-acute sequelae SARS-CoV-2 infection (SARS CoV-2 is the virus that causes COVID-19). PASC, which is most common in young women, typically affects those with only mild infections.

Infectious disease expert and White House medical adviser Dr. Anthony Fauci has speculated that PASC is the same as or very similar to ME/CSF, which can be triggered by infections, including mononucleosis and Lyme disease. Dr. Systrom and colleagues (along with other research teams across the country) are using CPET to better understand PASC, in hopes of paving the way for effective treatments.

Image: © Tashi-Delek/Getty Images

Dyspnea on exertion – Dr. Vertebrov

Dyspnea on exertion is a condition that is manifested by a subjective feeling of lack of air and difficulty breathing. It can occur during a run, an intense workout, or just climbing stairs. But in some cases, such a state appears even at rest. In this situation, it is important to consult a doctor to conduct a thorough examination of the body. Let’s consider this state in more detail.

The causes of shortness of breath can be both overweight and anemia (low hemoglobin in the blood), but the most common culprits are diseases of the cardiovascular system. “Cardiac” shortness of breath is accompanied by a violation of blood circulation, which causes insufficient distribution of oxygen through the cells of our body. As a result, an excessive amount of carbon dioxide accumulates in the blood, which causes the body to turn on a compensation mechanism that speeds up breathing in order to increase the amount of oxygen supplied.

When shortness of breath during exercise should alert? Suppose you walk the same route all the time, for 10-15 minutes at your usual pace. And then one day you noticed that it was more difficult to walk: there was not enough breath, you need to stop and stand for a while. Movement with stops is the first sign of trouble, a signal that in response to normal physical activity, the frequency of respiratory movements increases (normally there should be 14-16 per minute).

The main and most frequent sign of heart failure is shortness of breath , which occurs not only during physical exertion , but also at rest. This is always a serious reason to make an appointment with a cardiologist.

Shortness of breath is a fairly common manifestation of heart disease. It’s hard to describe her. It is a feeling of lack of air (oxygen). The term dyspnea (shortness of breath) doctors characterize various types of respiratory disorders: difficult, superficial, rapid.

• Dyspnea is very characteristic of heart failure and is associated mainly with organic lesions of the organs of the cardiovascular system, usually manifests itself on inspiration.
• The most severe form of shortness of breath in heart failure is nocturnal attacks. The patient cannot sleep because the dyspnea is worse when lying down and the person suffocates. This is explained by the fact that as soon as a person takes a horizontal position, the blood flow to the heart from the veins increases, and it is not able to cope with this flow. In the pulmonary vessels, blood stagnation occurs, as a result of which shortness of breath appears. As a result, patients have to sleep sitting up with their feet on the floor. In this position, part of the blood is sent to the veins, facilitating the work of the heart. And these patients feel most comfortable sitting on a chair.
• Often, shortness of breath is associated not with heart disease, but with obesity. Being overweight adds work to the heart and can cause shortness of breath even with little exercise. How shortness of breath manifests can help determine its cause.

But sometimes shortness of breath can signal acute circulatory failure or pulmonary edema. Ultrasound diagnostics of the heart, a daytime study of the heart rate, electrocardiographic observation and other studies will help to find out the true cause of rapid breathing in cardiac pathology. If shortness of breath occurs at rest, this is not a good sign, a signal of serious disturbances in the functioning of the body. Sudden and rapidly growing, it may be the result of an embolism (blockage) of the vessels of the lungs or a rupture of the lung tissue. Its appearance at night is most often the result of a disruption in the heart rhythm, the development of acute heart failure, an attack of cardiac or bronchial asthma.

Be aware that shortness of breath does not just happen and be aware of this symptom. Sign up for a consultation with a cardiologist and find out the cause of the growing symptoms. Take care of yourself, listen to your body and stay healthy.

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Shortness of breath at rest and on exertion. Causes, types and treatment of shortness of breath

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Khudarova Victoria Marklenovna

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Shortness of breath is a violation of the rhythm, frequency and depth of breathing, accompanied by a feeling of lack of air. The medical term for shortness of breath is dyspnea . As a rule, the breath of a person suffering from shortness of breath becomes more frequent and noisy. By these signs, people around usually easily establish the presence of this symptom. Patients define this condition, saying that “there is shortness of breath.”

Types of dyspnea

With significant physical exertion, the body does not have enough oxygen, so usually in such cases, the respiratory rate increases. This is the so-called physiological dyspnea . However, if shortness of breath occurs during light exertion or at rest (for example, in the supine position), then its nature is pathological.

Of great importance is which stage of breathing causes difficulty – inhalation or exhalation. Inspiratory dyspnea is called inspiratory dyspnea , and expiratory dyspnea is called expiratory dyspnea . Often there is also mixed shortness of breath, in which both inhalation and exhalation are difficult.

Causes of breathlessness

Shortness of breath is caused by various reasons. The most common causes of shortness of breath are:

• diseases of the cardiovascular system . Cardiovascular pathologies lead to insufficient blood circulation. Organs do not receive the necessary amount of oxygen, carbon dioxide accumulates in the blood. The body reacts to such a state by increasing breathing – more air is pumped through the lungs per unit of time. Shortness of breath due to cardiac pathology occurs or intensifies after physical exertion or in the supine position. In a sitting or semi-sitting position, shortness of breath disappears. Such shortness of breath is characterized by difficulty in breathing;
• pathologies of the respiratory system . Shortness of breath may be due to the occurrence of obstacles to the passage of air through the respiratory tract, for example, when narrowing the lumen of the bronchi. Therefore, shortness of breath is a typical symptom of bronchial asthma. In this case, breathing out is difficult. Also, shortness of breath can be caused by a decrease in the respiratory surface of the lung tissue. As a result of such a decrease, in order to maintain the required amount of oxygen entering the blood, more intensive work of the lungs is required, that is, a more frequent breath. The list of diseases of the respiratory system, in which shortness of breath can be observed, is extensive and includes such dangerous pathologies as tumors, pneumonia, chronic obstructive pulmonary diseases and others;
• anemia . The lack of red blood cells (erythrocytes) and hemoglobin leads to the fact that even with normal functioning of the heart and lungs, the blood is not able to provide the organs with the necessary amount of oxygen, and the body tries to compensate for this by increasing the respiratory rate;
• neuroses and panic attacks . In this case, a clinical examination does not reveal pathologies of the heart and lungs, but subjectively the patient experiences a lack of air, and psycho-emotional changes lead to increased breathing.
• Obesity and diabetes also often lead to shortness of breath.

Treating dyspnoea

Shortness of breath is not an independent disease, but a symptom indicating a malfunction of certain organs. To facilitate the diagnosis of the disease, before visiting a doctor, try to answer the following questions:

• when did you notice that you were short of breath?
• Does shortness of breath always occur after physical exertion, or does it bother you even at rest?
• Which is more difficult, inhaling or exhaling?
• In what position does it become easier to breathe?
• What other symptoms bother you? It can be chest pain, swelling, weakness, dizziness, cough, fever.

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When do you need medical attention for shortness of breath?

Shortness of breath may be constant or paroxysmal. A sharp difficulty in breathing, in which the patient feels an acute lack of air, is called suffocation.