Dr. Jacqueline Gerhart: What exactly is dyspnea?
Madison, Wisconsin - UW Health Family Medicine physician Jacqueline Gerhart writes a column that appears Tuesdays on madison.com and in the Wisconsin State Journal. Columns are re-published here with permission.
Dear Dr. Gerhart,
I was recently diagnosed with dyspnea and am not very familiar with it. Does having this make you more at risk when surgery is necessary, for example, hip replacement? Is this a heart or lung issue, or both?
Dyspnea is generally defined as "shortness of breath" or "difficulty breathing." Dyspnea can be the body's normal response to increased work. For example, when exercising, your muscles and organs need more oxygen, and therefore your body increases its breathing rate to accommodate. This makes you feel short of breath. However, dyspnea can also be abnormal, or can indicate underlying problems — often in your heart or lungs. Asthma, pneumonia, heart failure or a heart attack are all conditions where people may experience dyspnea. Dyspnea can also be from mental causes (like anxiety or panic attacks), low blood counts (like anemia), medications (like in an allergic reaction), or nerve and muscle problems (like in spinal cord injuries). Children can also have dyspnea from respiratory viruses like influenza, congenital problems like cystic fibrosis, or obstruction of their throat from choking on objects or food.
Most often, when health care providers use the term dyspnea, they are referring to a heart or lung concern. Simplistically, we breathe in air, and the lungs allow the passage of that air — which contains oxygen — into the blood. The oxygenated blood is then pumped throughout the body, based on the heart's ability to contract and relax (or pump). This process can be compromised, causing dyspnea. For example, in a condition called congestive heart failure, the ability to contract or relax the heart is impaired. Symptoms of people with congestive heart failure include "dyspnea on exertion" or "paroxysmal nocturnal dyspnea." The first — dyspnea on exertion — means that even with small tasks such as climbing up a few stairs, people become short of breath. The second — paroxysmal nocturnal dyspnea — is when patients lay down at night, they feel more short of breath, and may need to sleep on a few pillows, or in the recliner to breathe more easily.
Regarding your dyspnea and surgical risk — your surgeon will likely request your primary care physician perform a pre-operative assessment to evaluate your dyspnea. This evaluation includes measuring your vital signs such as your blood pressure, pulse, respiratory rate and oxygen in your blood (called oxygen saturation). We will listen to your heart and lungs, evaluate your current medications, and may order special testing to better understand your surgical risk. In general, surgical risk is related to your age, the type of surgery, your chronic medical conditions, and any acute circumstances (such as an emergency need for surgery, or acute organ dysfunction). These factors impact your response to anesthesia, your tolerance of the procedure, and your ability to recover without complications.
Even without underlying dyspnea, you may still have breathing difficulty after surgery. For example, after hip surgery, you likely will be unable to walk while your hip heals — putting you at increased risk for clots in the veins in your legs. If you were to get a clot in your leg, there is a possibility the clot could travel to your lungs, causing dyspnea. Other complications causing dyspnea include generalized weakness, deconditioning, or infection (like pneumonia). To help prevent these problems, your surgeon may put you on medications, arrange physical therapy, or encourage you to practice deep breathing. And, when you are able to walk again, remember that exercise is key to keeping your heart and lungs in shape.
Thanks for the question!
This column provides general health information and is not specific advice intended for any particular individual(s). It is not a professional medical opinion or a diagnosis. Always consult your personal health care provider about your concerns. No ongoing relationship of any sort (including but not limited to any form of professional relationship) is implied or offered by Dr. Gerhart to people submitting questions.
Date Published: 01/24/2012