Shortness of breath: A common reason for calling the doctor

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Shortness of breath: A common reason for calling the doctor

October 20, 2016-
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Know when difficulty breathing is an emergency.

Shortness of breath can occur after climbing stairs or running after a child. It can be caused by anxiety. And it can also be evidence of a serious heart or lung condition. That’s the problem: when is shortness of breath the sign of a serious problem?

“If you have a serious illness and delay getting care, the consequences can be life-threatening. That’s why you should call your doctor,” says Dr. Lee, who advises against sending an email that might not be read for hours.

It’s normal to be short of breath for a short period after strenuous exercise, at high altitudes, or upon sudden exposure to very hot or cold temperatures. Generally speaking, prolonged and lasting shortness of breath reflects an underlying medical condition. This requires medical attention, but is not usually an emergency.

Shortness of breath that’s sudden and severe—even if it doesn’t last long—may mean it’s time for immediate medical care. Worrisome symptoms include shortness of breath with any of the following:

Chest pain or chest discomfort. Possible conditions include heart attack, a tear in the aorta, or a blood clot in the lungs.
Swollen ankles and feet. This could be a sign of heart failure.
Fever. This may be caused by a number of infections.
Unusual fatigue. Possible conditions include stiffening of the lung arteries (pulmonary hypertension), lung disease, or anemia.
Painful cough with blood or yellow, green, or reddish mucus. Possible conditions include a blood clot in the lung, lung cancer, or pneumonia.
Wheezing and coughing. You may be having an asthma attack or suffering a lung infection.

Be prepared: Know the answers to these seven questions your doctor should ask

Before you call your doctor because you are short of breath, prepare to answer the following questions. They will help your doctor assess the urgency of your situation. If your doctor doesn’t ask these questions, Dr. Lee advises that you volunteer the information.

What does the chest pain feel like? Tell your doctor if it’s a sharp and stabbing pain or if it feels more like a dull pressure. The pain of a heart attack often feels more like dull pressure than a stabbing pain. Stabbing pain, however, may signal any of several different urgent conditions that require emergency care.
Are you sweating profusely? This symptom often accompanies a heart attack and other serious conditions that trigger the body’s flight-or-fight response.
Do you have trouble breathing when you lie down? This is a common symptom of heart failure caused by fluid buildup in the lungs.
Are your legs or ankles swollen? Fluid buildup in the extremities is one sign of heart failure.
Do you have a cough or a fever? Your shortness of breath could be caused by a respiratory infection such as pneumonia.
How fast are you breathing? More than 20 breaths per minute is cause for concern. You might be hyperventilating. Drug overdoses (e.g., too much aspirin) or a wide range of medical conditions also cause these symptoms.
What is your heart rate? Check your heart rate by feeling for your pulse in your neck or wrist. Count how many heartbeats you feel in 15 seconds, and multiply this number by four to get the number of beats per minute. If your heart is beating more than 90 times per minute, it may be struggling. You could be having a panic attack, but shortness of breath plus a rapid heart rate may be a sign of almost any significant heart or lung disease.

How doctors identify an emergency

When you call, your doctor’s first job will be to consider the possibility that you are experiencing a life-threatening event, such as a heart attack or a blood clot in the lungs (pulmonary embolism). If you are, you need to be seen quickly—within the hour, if possible.

Most doctors will advise you to come in to be seen immediately or to go directly to the emergency department if you have

unexplained shortness of breath experienced for the first time
shortness of breath at rest
shortness of breath accompanied by chest pain or pressure, lightheadedness, or sweating
worsening shortness of breath, if you already have heart failure, asthma, or emphysema.

“No one with any of these warning signs should wait until morning,” says Dr. Lee.

Certain other conditions causing shortness of breath may be serious but not immediately life-threatening, and evaluation might be deferred until the next day. For example, a person with heart or lung disease who becomes short of breath more easily than usual with activity could probably be seen in the next day or so.

But why take that chance?

“We advise people to play it safe. When in doubt, call your doctor, even if it’s the middle of the night or a weekend. If your doctor recommends you be looked at right away, I recommend you follow that advice,” says Dr. Lee.