In dyspnea – colloquially called shortness of breath – (synonyms: Exertional dyspnea; hyperpnea; hyperventilation dyspnea; nocturnal dyspnea; orthopnea; paroxysmal dyspnea; resting dyspnea; tachypnea; trepopnea; ICD-10-GM R06.0: Dyspnea) is the subjective symptom of shortness of breath, also called air hunger. Dyspnea is a leading symptom of diseases of the respiratory system. Different forms of dyspnea can be distinguished:
- Pulmonary – the cause here is in the lungs as in pneumothorax (accumulation of air next to the lungs; usually an acute event, depending on the severity life-threatening clinical picture).
- Cardial – here the cause is in the heart, as in heart failure* (heart failure).
- Thoracic (skeletal) – in this case, there are fractures (bone fractures) or malformations of the chest.
- Central – in this case, the dyspnea is due to disorders of the central nervous system (CNS).
- Metabolic – here are metabolic disorders such as acidosis (hyperacidity of the blood).
- Psychogenic – in the case of psychological stress (anxiety, panic, anger) or disease.
- Pharyngo-tracheal – here the cause is in the area of the pharynx and / or trachea.
* Patients suffering from higher systolic heart failure struggle to breathe when bending forward, for example, when putting on socks or shoes. This form of dyspnea is called bendopnea (to bend, meaning to stoop). These patients are characterized by increased left atrial (“pertaining to the left atrium“) and pulmonary capillary (“pertaining to the lungs”) pressures while sitting. In addition, shortness of breath can be distinguished by increased oxygen demand, as during exercise, or decreased oxygen supply, as at high altitude. Furthermore, dyspnea can be functionally categorized as follows:
- Physical exertion
- Exertional dyspnea – dyspnea due to exertion.
- Resting dyspnea – occurrence of dyspnea at rest.
- Body position
- Orthodeoxia (synonym: Platypnoea orthodeoxia syndrome [POS] – symptom complex with decrease in oxygen saturation on change of position from supine to sitting or standing; causes are cardiac (“heart-related”) anatomic defects such as persistent foramen ovale (PFO; patent foramen ovale), atrial septal defect (malformation of the heart in which the septum between the two atria of the heart is not completely closed), or atrial septal aneurysm (VSA) or Pulmonary (“lung-related”) causes such as ventilation-perfusion mismatch or pulmonary arteriovenous shunts; furthermore, hepatopulmonary syndrome (disorder of pulmonary gas exchange with arterial hypoxemia and intrapulmonary vascular dilatation).
- Orthopnea – dyspnea that occurs in the horizontal position and is ameliorated by sitting up; most severe dyspnea requiring the use of auxiliary respiratory muscles in the upright positionNote: Because patients with chronic heart failure frequently turn in bed (Greek : trepo) to get air (pneuma), the symptom is also called trepopnea.
- Non-positional dyspnea
- Mode of onset
- Sudden onset of shortness of breath
- Slowly beginning shortness of breath
Furthermore, dyspnea can be divided into two main categories: continuous dyspnea and attacks of dyspnea (duration: seconds to hours) and acute and chronic dyspnea (> 4 weeks). Dyspnea can be a symptom of many diseases (see under “Differential diagnoses”). Sex ratio: Men are more frequently affected than women. This is likely due to the fact that conditions associated with dyspnea, such as COPD (chronic obstructive pulmonary disease) and heart disease, are more common in men. Frequency peak: the disease occurs more frequently with increasing age. The prevalence (disease frequency) is 6-27% in general medical or internal medicine practices (in Germany). Course and prognosis: Acute dyspnea requires immediate diagnosis so that rapid specific therapy can be administered as early as possible. Regardless, immediate emergency management is required.The prognosis of dyspnea depends on the type and severity of the underlying disease. It is not uncommon for dyspnea to be associated with pain and cause panic in the affected individual.Note: In elderly patients, dyspnea of unclear etiology (origin) can be associated with cardiac and noncardiac dysfunction and with obesity. In one study, only 10% of dyspnea patients met the criteria for heart failure (heart failure) with preserved ejection fraction (HFpEF)…
Comorbidities (concomitant diseases): typical concomitant diseases are cardiac diseases (heart failure/heart failure, pulmonary hypertension (PH)/pulmonary hypertension, acute coronary syndrome (AKS resp. ACS, acute coronary syndrome; spectrum of cardiovascular diseases ranging from unstable angina pectoris (iAP; unstable angina, UA) to the 2 major forms of myocardial infarction (heart attack), non-ST-segment elevation myocardial infarction (NSTEMI) and ST-segment elevation myocardial infarction (STEMI)) and pulmonary disorders (bronchial asthma, chronic obstructive pulmonary disease (COPD), pneumonia/pneumonia), as well as other conditions (anemia/anemia, hyperventilation, panic disorder).
