Shortness of breath a warning sign for heart, lung diseases

Shortness of breath, or dyspnoea after some exertion, can sometimes be associated with reduced fitness and ageing. However, GPs should not overlook the possibility that the symptom could be a warning sign of heart and lung diseases, experts caution.

Heart and lung diseases were the top two causes of death in Malaysia in 2018 at 15.6 and 11.8 percent, respectively. [Available at www.dosm.gov.my/v1/index.php?r=column/pdfPrev&id=RUxlSDNkcnRVazJnakNCNVN2VGgrdz09 Accessed on 21 September] The main symptoms for both diseases is shortness of breath, contributing to the ambiguity. To make matters worse, shortness of breath can also be due to allergies, anxiety attacks or even anaemia.

According to Dr Tee Chee Hian, a consultant cardiologist in private practice, an accurate diagnosis may require advanced testing. “Like your heartbeat, the regular inhale and exhale of your breathing is something you usually don’t notice—until something doesn’t feel quite right. As these two organ systems are so intertwined, one always affects the other. In fact, about 60 percent of people with heart disease also have lung disease,” Tee said. 

Shortness of breath due to heart disease
Acute shortness of breath can occur during a heart attack or pulmonary embolism, when a blood clot detaches from a vein in the leg or pelvis and lodges itself in the lung.

Shortness of breath can also present itself slowly over time. In such instances, it usually occurs during physical exertion and is attributable to aortic stenosis, arrhythmia, coronary artery disease or heart failure. Additional tell-tale signs include oedema of the legs, chest pain, dizziness and lethargy.

Tee said anyone presenting with these symptoms should be treated for their possible underlying conditions immediately. Should a heart condition be the suspected cause for the shortness of breath, an echocardiogram will reveal the valve morphology, heart chambers and contractility of the heart muscles. Additional tests come in the form of a 24-hour electrocardiogram (ECG) monitoring, exercise stress test, and a computerized tomography (CT) scan of the coronary vessels. Should it be necessary, angioplasty can be performed to relieve blockages in the coronary artery.

Shortness of breath due to lung disease
Shortness of breath symptoms can also be directly attributed to the lungs, said Dr Nurul Yaqeen Mohd Esa, a consultant respiratory and internal medicine physician in a private institution. 

Nurul noted that complaints of chest tightness or wheezing may be caused by asthma, but worsening problems could be a red flag for chronic obstructive pulmonary disease (COPD). “It could also be a symptom of pneumonia, a lung infection or pulmonary fibrosis (scarring of the lungs). Other causes could be a tuberculosis infection, lung cancer, bronchiectasis or a fungal lung infection.”

Lung conditions can be diagnosed with a chest X-ray or lung scan. She noted that some scans may not yield a definite diagnosis and those patients continue to experience discomfort for an extended period before an accurate diagnosis is achieved.