The following symptoms and complaints may occur along with dyspnea (shortness of breath):
Leading symptom
- Dyspnea (= subjective symptom of shortness of breath or dyspnea, also air hunger).
Associated symptoms
- Anxiety
- Increased effort when breathing
- Tachypnea (respiratory rate > 20-25 breaths/min, in adults; for age-dependent definition of tachypnea, see “Respiratory rate measurement” below).
- Hyperpnea (deepened breathing).
Note: Because women have a lower absolute FEV1 (2.7 vs. 3.7 liters) compared with men, the symptom of exertional dyspnea (mMRC ≥ 1/dyspnea on fast walking or slight ascents) is reported by 27% of women but only 14% of men in the general population.
Warning signs (red flags)
- Anamnestic information:
- Acute dyspnea + hypertension (high blood pressure) + chest pain (chest pain) → think: acute coronary syndrome (AKS or. ACS, acute coronary syndrome; spectrum of cardiovascular disease ranging from unstable angina pectoris (iAP; engl unstable angina, UA; “chest tightness”; suddenly occurring pain in the heart area with inconstant symptoms) to the two main forms of myocardial infarction (heart attack), the non-ST elevation myocardial infarction (NSTEMI) and ST elevation myocardial infarction (STEMI)), aortic aneurysm (bulging (aneurysm) of the aorta) or pulmonary embolism (occlusion of one or more pulmonary arteries by a blood clot).
- Respiratory synchrony pain with resting dyspnea (onset of dyspnea at rest) → think of: Pulmonary embolism
- Increase in dyspnea after lying down (orthopnea) → think of: Heart failure (cardiac insufficiency) or toxic pulmonary edema (water retention in the lungs)Note: Because patients with chronic heart failure frequently turn over in bed (Greek : trepo) to get air (pneuma), the symptom is also called trepopnea.
- Dyspnea when bending down (bendopnea) → think of: Heart failure
- General weakness or fatigue that cannot be adequately explained by other findings → think: pulmonary hypertension (PH; increase in vascular resistance and thus blood pressure in the pulmonary circulation)
- Use of respiratory accessory muscles, nasal wings, possibly intercostal retractions → severe respiratory failure.
- Barking, dry irritating cough → think of: Epiglottitis (epiglottitis), which can lead to life-threatening respiratory distress.
- Inspiratory stridor (breathing sound/hissing or whistling on inspiration) + acute dyspnea → think of: Upper airway obstruction (dyspnea may progress to asphyxia (threatened asphyxia); retractions in the jugulum (small depression in the front of the neck) and epigastrium (abdominal region between the costal arch and the belly button) and increasing cyanosis).
- Expiratory stridor + acute dyspnea → think of: Bronchospasm (cramping of the muscles surrounding the airways); if in addition skin symptoms (redness, wheals, etc.), hypotension (drop in blood pressure) and tachycardia (heartbeat too fast: > 100 beats per minute) → think of: anaphylactic reaction
- Acute confusion → signs of severe hypoxia (lack of oxygen supply to tissues).
- Chronic dyspnea (> 4 weeks) → think of: Bronchial asthma, chronic obstructive pulmonary disease (COPD), pulmonary hypertension (pulmonary hypertension), interstitial lung disease, or pleural effusions.
- Cyanosis (bluish discoloration of the skin and mucous membranes) → acute emergency.
Acute life-threatening pulmonary dyspnea causes.
- Acute pulmonary embolism-partial (partial) or complete obstruction of a pulmonary artery due primarily to pelvic-leg thrombosis (approximately 90% of cases)
- Exacerbations (significant exacerbation of a clinical picture) of chronic obstructive pulmonary disease (“chronic obstructive pulmonary disease”, COPD) or bronchial asthma
- Obstructions of the upper respiratory tract
- Pneumothorax – collapse of the lung caused by an accumulation of air between the visceral pleura (lung pleura) and the parietal pleura (chest pleura).
- Pneumonia (pneumonia)
- Pulmonary hemorrhage – bleeding from the airways.
