To Your Good Health: Shortness of breath has many causes
DEAR DR. ROACH: A recent column discussed shortness of breath on exercise. My aunt had this exact same scenario, and it turned out to be lung cancer. She ignored it for a while, then when she got checked out, it was too late — she had stage 4 lung cancer. Please tell this person to see an oncologist. I write this with a heavy heart and tears. I miss my aunt. — Anon.
ANSWER: I am very sorry about your aunt.
Shortness of breath is a common concern, and it has many, many causes. However, the vast majority of them, if they will ever be diagnosed at all, will be due to a heart or lung problem, low blood count or anxiety disorder.
There are a number of heart problems that can cause shortness of breath. The term “dyspnea,” Greek for “bad breathing,” is used medically. Heart failure and blockages in the arteries are the most common. Heart problems are often the first to be considered, as it may be the symptoms of an impending heart attack.
Similarly, there are different lung issues that can cause trouble breathing. Asthma, chronic obstructive lung disease — that is, emphysema and chronic bronchitis — and the many forms of interstitial lung disease, such as pulmonary fibrosis, all are common.
Low blood count (anemia) from any cause can trigger difficulty breathing, especially with exercise.
Anxiety disorders, particularly panic attack, can cause recurrent episodes of difficulty breathing associated with severe anxiety. Physicians need to be meticulous to do a thorough evaluation of possible causes, even in someone with clear anxiety, before ascribing symptoms to psychological causes. It’s possible the anxiety is due to, or worsened by, the shortness of breath from heart or lung problems, for example.
Initial testing for a person with new onset of significant trouble breathing usually includes an EKG, chest X-ray, oxygen level and blood count. Further testing depends on other symptoms or risk factor a person may have and the results of the initial testing.
Lung cancer, unfortunately, usually does not have many worrisome symptoms until it is advanced. Cough and weight loss occur more often than shortness of breath does. Even so, a physician needs to be concerned about lung cancer, especially in people with risk factors, but recalling that some, especially older women, may get lung cancer with no history of smoking.
Oncologists are generally consulted when the diagnosis of cancer is made.
DEAR DR. ROACH: A recent column discussed dizziness upon rising. My husband suggested to me to breathe, and not hold my breath, as I stand up. I find that this works very well for me. — S.A.
ANSWER: Orthostatic hypotension is dizziness upon rising, and it’s a common problem, especially in older people and among those taking high blood pressure medicines. I had mentioned adequate salt and water intake and compression stockings, but after reading your letter I did find a study showing that slow, deep breathing (six breaths a minute) improved symptoms of orthostatic hypotension. I am publishing your letter in hopes that simple breathing exercises, at no cost and no risk of medicine side effects, may help other readers.
DEAR DR. ROACH: I am a man in his late 50s. Doctors told me for years I had mitral valve prolapse but recently, some doctors say I don’t have it. I have had several EKGs and echocardiograms, which all seem to be normal. Who should I believe? — K.S.
ANSWER: The mitral valve separates the left atrium from the left ventricle and prevents blood from flowing backward into the left atrium when the ventricle contracts. Mitral valve prolapse is when the valve leaflets billow backward excessively into the ventricle. Often, there is associated backward flow of blood into the ventricle. This is called regurgitation.
I suspect you were given the diagnosis of MVP in the 1980s or 1990s, before echocardiography for this condition was well standardized. As many as 10% to even 20% of people were diagnosed with MVP back then. With current standards, about 2%-3% of the population will have MVP.
MVP can cause rhythm disturbances. It is associated with several different symptoms and, as mentioned, can cause mitral regurgitation. Mitral regurgitation severe enough to cause symptoms that do not respond to medication is the most common indication for surgical treatment.