Breathlessness

What Is Breathlessness?

Breathlessness (also called dyspnoea) is difficulty breathing, rapid breathing or a sense of having to work harder for each breath. You might notice it only on exertion, such as climbing stairs, or at rest in more advanced cases. It is a symptom rather than a diagnosis, so the aim of assessment is to find the underlying cause.

When Should You Seek Assessment for Breathlessness?

Call 999 or seek urgent medical attention if breathlessness:

• Comes on suddenly and is severe
• Occurs at rest for the first time
• Comes with chest pain, palpitations or collapse
• Comes with a cough producing pink or frothy sputum

LivingCare is a specialist outpatient service and is not an emergency care facility. If your symptoms are sudden or severe, call 999.

For persistent or unexplained breathlessness, it is worth arranging an assessment. Consider booking if it:

• Limits your ability to exercise or manage everyday activities
• Wakes you at night, or makes you sleep propped up on extra pillows
• Has been present for several weeks and is gradually worsening
• Comes with ankle swelling, tiredness or palpitations
• Has not been explained by a previous respiratory assessment

How Breathlessness Is Assessed

A cardiologist will start with your history and an examination, then choose the most useful tests. Assessment usually involves a resting ECG to check the heart's rhythm and an echocardiogram to look at heart structure and function. Ambulatory ECG monitoring can pick up intermittent rhythm problems, and cardiac blood tests including BNP help indicate heart failure. You can find the full pathway on our cardiology department page.

What Might Be Causing My Breathlessness?

Breathlessness has both cardiac and non-cardiac causes. Cardiac causes include heart failure, coronary artery disease, valve disease such as aortic stenosis, and arrhythmias (abnormal heart rhythms). Around 920,000 people in the UK are living with heart failure, a condition in which breathlessness is a cardinal symptom [1]. Where it occurs alongside chest pain, that combination is worth assessing promptly.

Common non-cardiac causes include asthma or chronic obstructive pulmonary disease (COPD), pulmonary embolism (a blood clot in the lungs), anaemia and anxiety. Where the cause looks respiratory or otherwise non-cardiac, we will explain this and coordinate onward referral so you reach the right team.

References

1. British Heart Foundation - Incidence and prevalence of heart failure