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Dr Diana R Holdright

Consultant Cardiologist

Dr Diana Holdright

Common Problems - Breathlessness

Breathlessness, or dyspnoea, is a common symptom of several medical disorders. Increasing age and lack of physical activity can cause some degree of breathlessness, but laboured breathing should always be fully investigated by a doctor to look for an underlying heart or lung disorder.

If the heart muscle is not pumping effectively, pressure can build up within the lungs and the chambers of the heart, creating the sensation of breathlessness. If the muscle impairment is mild, breathlessness is only felt with significant exercise, but increasing muscle damage causes breathlessness with even mild activity and is perhaps more noticeable when lying down in bed, such that a patient may start to sleep with more pillows than before.  As the symptom progresses, fluid retention and swelling may also become noticeable, most commonly in the form of swollen ankles or distention of the abdomen.

The most common cardiac cause of breathlessness in the Western world is coronary artery disease, furring up of the coronary arteries. If an artery blocks completely and causes a heart attack, the heart muscle that was supplied by that artery will die, healing with time to leave a scar. The larger the scar, the greater the effect on the remaining healthy heart muscle, and the more likely it is that a patient may feel breathless.

Other causes of breathlessness include malfunctioning heart valves that may narrow down and/or leak, and various abnormalities of the heart muscle itself, which may be inherited (the cardiomyopathies), or acquired (for example, following a viral infection of the heart, a long period of alcohol excess, or treatment with certain drugs which can be toxic to the heart, such as certain cancer drugs). Sometimes the outer lining of the heart (the pericardium) can become inflamed and thickened over time, creating a straight-jacket effect on the heart and inhibiting normal function, a condition known as constrictive pericarditis.  This too has many different causes, such as viral infections, surgery or trauma, TB, and can occur following a heart attack or after radiotherapy.  The symptoms are typically insidious, including breathlessness, fatigue and fluid retention, and diagnosis can be delayed and difficult.

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Common Problems - Breathlessness