Skip to main content

Dyspnea

  • Chapter
  • First Online:
Practical Cardiology

Abstract

Dyspnea has been variously described as the sensation of breathlessness or of difficult or uncomfortable breathing. The American Thoraci Society defines dyspnea as “… a term used to characterize a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity. The experience arises from interactions among multiple physiological, psychological, social, and environmental factors and may induce secondary physiological and behavioral responses” [1]. Some degree of dyspnea is normal at high altitude or in the context of vigorous exercise; dyspnea is abnormal when it occurs at levels of activity and in environmental circumstances for which normal individuals would not be breathless. The severity of dyspnea that an individual experiences for a given activity appears to be related to the level of ventilation required for that activity in relation to the ventilatory capacity of the individual.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Society AT. Dyspnea. Mechanisms, assessment, and management: a consensus statement. American Thoracic Society. Am J Respir Crit Care Med. 1999;159(1):321–40.

    Google Scholar 

  2. Kroenke K, Arrington ME, Mangelsdorff AD. The prevalence of symptoms in medical outpatients and the adequacy of therapy [see comments]. Arch Intern Med. 1990;150(8):1685–9.

    CAS  PubMed  Google Scholar 

  3. Ailani RK, Ravakhah K, DiGiovine B, Jacobsen G, Tun T, Epstein D, West BC. Dyspnea differentiation index: a new method for the rapid separation of cardiac vs pulmonary dyspnea. Chest. 1999;116(4):1100–4.

    CAS  PubMed  Google Scholar 

  4. Maisel A, Krishaswamy P, Nowak R, McCord J, Hollander J, Duc P, Omland T, Storrow A, Abraham W, Wu A, Clopton P, Steg P, Westheim A, Knudsen C, Perez A, Kazanegra R, Herrmann H, McCullough P, B. N. P. M. S. Investigators. Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure. N Engl J Med. 2002;347(3):161–7.

    CAS  PubMed  Google Scholar 

  5. Burke M, Cotts W. Interpretation of B-type natriuretic peptide in cardiac disease and other comorbid conditions. Heart Fail Rev. 2007;12:23–6.

    CAS  PubMed  Google Scholar 

  6. Baughman K. B-type natriuretic peptide—a window to the heart. N Engl J Med. 2002;347(3):158–9.

    PubMed  Google Scholar 

  7. Rodeheffer R. Measuring plasma B-type natriuretic peptide in heart failure. J Am Coll Cardiol. 2004;44(4):740–9.

    CAS  PubMed  Google Scholar 

  8. Hammerer-Lercher A, Ludwig W, Falkensammer G, Muller S, Neubauer E, Puschendorf B, Pachinger O, Mair J. Natriuretic peptides as markers of mild forms of left ventricular dysfunction: effects of assays on diagnostic performance of markers. Clin Chem. 2004;50(7):1174–83.

    CAS  PubMed  Google Scholar 

  9. Alibay Y, Beauchet A, Mahmoud R, Brun-Ney D, Alexandre J, Benoit M, Dubourg O, Aegerter P, Boileau C, Jondeau G, Puy H. Analytical correlation between plasma N-terminal pro-brain natriuretic peptide and brain natriuretic peptide in patients presenting with dyspnea. Clin Biochem. 2004;37:933–6.

    CAS  PubMed  Google Scholar 

  10. Redfield M, Rodeheffer R, Jacobsen S, Mahoney D, Bailey K, Burnett J Jr. Plasma barin natriuretic peptide concentration: impact of age and gender. J Am Coll Cardiol. 2002;40:976–82.

    CAS  PubMed  Google Scholar 

  11. Loke I, Squire I, Davies J, Ng L. Reference ranges for natriuretic peptides for diagnostic use are depending on age, gender and heart rate. Eur J Heart Fail. 2003;5:599–606.

    CAS  PubMed  Google Scholar 

  12. Cataliotti A, Mallatino L, Jougasaki M, al e. Circulating natriuretic peptide concentration in patients with end-stage renal disease: role of natriuretic peptide as a biomarker for ventricular remodelling. Mayo Clin Proc. 2001;76:1111–9.

    CAS  PubMed  Google Scholar 

  13. Akiba T, Tachibana K, Togashi K, Hiroe M, Marumo F. Plasma human brain natriuretic peptide in chronic renal failure. Clin Nephrol. 1995;44:S61–4.

    CAS  PubMed  Google Scholar 

  14. Knudsen C, Riis J, Finsen A, Eikvar L, Muller C, Westheim A, Omland T. Diagnostic value of a rapid test for B-type natriuretic peptide in patients presenting with acute dyspnoe: effect of age and gender. Eur J Heart Fail. 2004;6:55–62.

    PubMed  Google Scholar 

  15. Mueller C, Laule-Kilian K, Frana B, Rodriguez D, Rudez J, Scholer A, Buser P, Pfisterer M, Perruchoud A. The use of B-type natriuretic peptide in the management of elderly patients with acute dyspnoea. J Intern Med. 2005;258:77–85.

    CAS  PubMed  Google Scholar 

  16. Mueller C, Laule-Kilian K, Scholer A, Frana B, Rodriguez D, Schindler C, Marsch S, Perruchoud A. Use of B-type natriuretic peptide for the management of women with dyspnea. Am J Cardiol. 2004;94:1510–4.

    CAS  PubMed  Google Scholar 

  17. Mueller T, Gegenhuber A, Poelsz W, Haltmayer M. Diagnostic accuracy of B type natriuretic peptide and amino terminal proBNP in the emergency diagnosis of heart failure. Heart. 2005;91:606–12.

    CAS  PubMed  PubMed Central  Google Scholar 

  18. Januzzi J Jr, Camargo C, Anwaruddin S, Baggish A, Chen A, Krauser D, Tung R, Cameron R, Nagurney J, Chae C, Lloyd-Jones D, Brown D, Foran-Melanson S, Sluss P, Lee-Lewandrowski E, Lewandrowski K. The N-terminal Pro-BNP investigation of dyspnea in the emergency department (PRIDE) study. Am J Cardiol. 2005;95:948–54.

    CAS  PubMed  Google Scholar 

  19. Mueller C, Scholer A, Laule-Kilian K, Martina B, Schindler C, Buser P, Pfisterer M, Perruchoud A. Use of B-type natriuretic peptide in the evaluation and management of acute dyspnea. N Engl J Med. 2004;350:647–54.

    CAS  PubMed  Google Scholar 

  20. DePaso W, Winterbauer R, Lusk J, Dreis D, Springmeyer S. Chronic dyspnea unexplained by history, physical examination, chest roentgenogram, and spirometry. Analysis of a seven-year experience. Chest. 1991;100:1293–9.

    CAS  PubMed  Google Scholar 

  21. Martinez FJ, Stanopoulos I, Acero R, Becker FS, Pickering R, Beamis JF. Graded comprehensive cardiopulmonary exercise testing in the evaluation of dyspnea unexplained by routine evaluation. Chest. 1994;105(1):168–74.

    CAS  PubMed  Google Scholar 

  22. Pratter MR, Curley FJ, Dubois J, Irwin RS. Cause and evaluation of chronic dyspnea in a pulmonary disease clinic. Arch Intern Med. 1989;149(10):2277–82.

    CAS  PubMed  Google Scholar 

  23. Huang W, Resch S, Oliverira RKF, Cockrill BA, Systrom DM, Waxman AB. Invasive cardiopulmonary exercise testing in the evaluation of unexplained dyspnea: Insights from a multidisciplinary dyspnea center. Eur J Prev Cardiol. 2017;24(11):1190–9.

    Google Scholar 

  24. Charles J, Ng A, Britt H. Presentations of shortness of breath in Austria general practice. Aust Fam Phys. 2005;34(7):520–1.

    Google Scholar 

  25. Ambrosino N, Serradori M. Determining the cause of dyspnoea: linguistic and biological descriptors. Chron Respir Dis. 2006;3(3):117–22.

    CAS  PubMed  Google Scholar 

  26. Elliott M, Adams L, Cockcroft A, Macrae K, Murphy K, Guz A. The language of breathlessness. Use of verbal descriptions by patients with cardiopulmonary disease. Am Rev Respir Dis. 1991;144:826–32.

    CAS  PubMed  Google Scholar 

  27. Simon PM, Schwartzstein RM, Weiss JW, Fencl V, Teghtsoonian M, Weinberger SE. Distinguishable types of dyspnea in patients with shortness of breath [see comments]. Am Rev Respir Dis. 1990;142(5):1009–14.

    CAS  PubMed  Google Scholar 

  28. Scott JA, Mahler DA. Prospective evaluation of a descriptor model to diagnose the etiology of dyspnea. Chest. 1995:188S.

    Google Scholar 

  29. Small D, Gibbons W, Levy R, de Lucas P, Gregory W, Cosio M. Exertional dyspnea and ventilation in hyperthyroidism. Chest. 1992;101(5):1268–73.

    CAS  PubMed  Google Scholar 

  30. Martinez FJ, Bermudez-Gomez M, Celli BR. Hypothyroidism. A reversible cause of diaphragmatic dysfunction. Chest. 1989;96(5):1059–63.

    CAS  PubMed  Google Scholar 

  31. Cabanes L, Richaud-Thiriez B, Fulla Y, Heloire F, Vuillemard C, Weber S, Dusser D. Brain natriuretic peptide blood levels in the differential diagnosis of dyspnea. Chest. 2001;120:2047–50.

    CAS  PubMed  Google Scholar 

  32. Nielsen L, Svanegaard J, Klitgaard N, Egeblad H. N-terminal pro-brain natriuretic peptide for discreminating between cardiac and non-cardiac dyspnea. Eur J Heart Fail. 2004;6:63–70.

    CAS  PubMed  Google Scholar 

  33. Wright S, Doughty R, Pearl A, Gamble G, Whalley G, Walsh H, Gordon G, Bagg W, Oxenham H, Yandle T, Richards M, Sharpe N. Plasma amino-terminal pro-brain natriuretic peptide and accuracy of heart-faiulre diagnosis in primary care. A randomized, controlled trial. J Am Coll Cardiol. 2003;42(10):1793–800.

    CAS  PubMed  Google Scholar 

  34. Epler GR, McLoud TC, Gaensler EA, Mikus JP, Carrington CB. Normal chest roentgenograms in chronic diffuse infiltrative lung disease. N Engl J Med. 1978;298(17):934–9.

    CAS  PubMed  Google Scholar 

  35. Orens J, Kazerooni E, Martinez F, Curtis J, Gross B, Flint A, III LJ. The sensitivity of high-resolution CTin detecting idiopathic pulmonary fibrosis proved by open lung biopsy: A prospective study. Chest. 1995;108:190–15.

    Google Scholar 

  36. Diller P, Smucker D, David B, Graham R. Congestive heart failure due to diastolic or systolic dysfunction: frequency and patient characteristis in an ambulatory setting. Arch Fam Med. 1999;8(5):414–20.

    CAS  PubMed  Google Scholar 

  37. McComb BL, Ravenel JG, Steiner RM, Chung JH, Ackman JB, Carter B, Colletti PM, Crabtree TD, de Groot PM, Iannettoni MD, Jokerst C, Maldonado F, Kanne JP. ACR Appropriateness Criteria Chronic Dyspnea-Noncardiovascular Origin. J Am Coll Cardiol. 2018;15:S291–S301.

    Google Scholar 

  38. Vasan R, Benjamin E, Levy RD. Prevalance, clinical features and prognosis of diastolic heart failure: an epidemiologic prespective. J Am Coll Cardiol. 1995;26:1565–76.

    CAS  PubMed  Google Scholar 

  39. Miller M, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, Crapo R, Enright P, van der Grinten C, Gustafsson P, Jensen R, Johnson D, MacIntyre N, McKay R, Navajas D, Pedersen O, Pellegrino R, Viegi G, Wanger J. Standardisation of spirometry. Eur Respir J. 2005;26:319–38.

    CAS  PubMed  Google Scholar 

  40. Irvin C. Lung volumes. Sem Respir Med. 1998;19(4):325–34.

    Google Scholar 

  41. MacIntyre N, Crapo R, Viegi G, Johnson D, van der Grinten C, Brusasco V, Burgos F, Casaburi R, Coates A, Enright P, Gustafsson P, Hankinson J, Jensen R, McKay R, Miller M, Navajas D, Pedersen O, Pellegrino R, Wanger J. Standardisation of the single-breath determination of carbon monoxide uptake in the lung. Eur Respir J. 2005;26:720–35.

    CAS  PubMed  Google Scholar 

  42. Mohsenifar Z, Collier J, Belman MJ, Koerner SK. Isolated reduction in single-breath diffusing capacity in the evaluation of exertional dyspnea. Chest. 1992;101(4):965–9.

    CAS  PubMed  Google Scholar 

  43. Celli BR, Grassino A. Respiratory muscles: functional evaluation. Sem Respir Med. 1998;19(4):367–82.

    Google Scholar 

  44. Demedts M, Beckers J, Rochette F, Bulcke J. Pulmonary function in moderate neuromuscular disease without respiratory complaints. Eur J Respir Dis. 1982;63:62–7.

    CAS  PubMed  Google Scholar 

  45. Flaherty K, Wald J, Weisman K, Zeballos R, Schork A, Blaivas M, Rubenfire M, Martinez F. Unexplained exertional limitation: characterization of patients with a mitochondrial myopathy. Am J Respir Crit Care Med. 2001;164:425–32.

    CAS  PubMed  Google Scholar 

  46. Martinez FJ. Pulmonary function testing in the evaluation of upper airway obstruction. In: Norton M, editor. Atlas of the difficult airway. St. Louis: Mosby; 1996. p. 125–33.

    Google Scholar 

  47. Rubin L, Badesch D. Evaluation and management of the patient with pulmonary arterial hypertension. Ann Intern Med. 2005;143:282–92.

    PubMed  Google Scholar 

  48. Hansell D. High-resolution computed tomography in the evaluation of fibrosing alveolitis. Clin Chest Med. 1999;20:739–60.

    CAS  PubMed  Google Scholar 

  49. Klein JS, Gamsu G, Webb WR, Golden JA, Müller NL. High-resolution CT diagnosis of emphysema in symptomatic patients with normal chest radiographs and isolated low diffusing capacity. Radiology. 1992;182(3):817–21.

    CAS  PubMed  Google Scholar 

  50. Sterk P. Bronchoprovocation testing. Sem Respir Med. 1998;19(4):317–24.

    Google Scholar 

  51. Boldy D, Skidmore S, Ayres J. Acute bronchitis in the community: clinical features, infective factors, changes in pulmonary function and bronchial reactivity to histamine. Respir Med. 1990;84:377–85.

    CAS  PubMed  PubMed Central  Google Scholar 

  52. Hallett J, Jacobs R. Recurrent acute bronchitis: the association with undiagnosed bronchial asthma. Ann Allergy. 1985;55:568–70.

    CAS  PubMed  Google Scholar 

  53. Wasserman K, Hansen J, Sue D, Casaburi R, Whipp B. Principles of exercise testing & interpretation. including pathophysiology and clinical applications. Philadelphia: Lippincott Williams & Wilkins; 1999.

    Google Scholar 

  54. American Thoracic Society, and American College of Chest Physicians. ATS/ACCP statement on cardiopulmonary exercise testing. Am J Respir Crit Care Med. 2003;167:211–77.

    Google Scholar 

  55. Weisman I, Zeballos R. A step approach to the evaluation of unexplained dyspnea: the role of cardiopulmonary exercise testing. Pulm Perspect. 1998;15:8–11.

    Google Scholar 

  56. Weisman I, Zeballos R. Clinical evaluation of unexplained dyspnea. Cardiologia. 1996;41(7):621–34.

    CAS  PubMed  Google Scholar 

  57. Gardner W. The pathophysiology of hyperventilation disorders. Chest. 1996;109(2):516–34.

    CAS  PubMed  Google Scholar 

  58. Flaherty K, Weisman I, Zeballos R, Martinez F. The role of cardiopulmonary exercise testing for patients with suspected metabolic myopathies and other neuromuscular disorders. In: Weisman I, Zeballos R, editors. Clinical exercise testing. Basel: Karger; 2002. p. 242–53.

    Google Scholar 

  59. Hooper R, Thomas A, Kearl R. Mitochondrial enzyme deficiency causing exercise limitation in normal- appearing adults. Chest. 1995;107(2):317–22.

    CAS  PubMed  Google Scholar 

  60. Keogh B, Lakatos E, Price D, Crystal R. Importance of the lower respiratory tract in oxygen transfer. Exercise testing in patients with interstitial and destructive lung diseases. Am Rev Respir Dis. 1984;129(Suppl):S76–80.

    CAS  PubMed  Google Scholar 

  61. Risk C, Epler G, Gaensler E. Exercise alveolar-arterial oxygen pressure difference in interstitial lung disease. Chest. 1984;85(1):69–74.

    CAS  PubMed  Google Scholar 

  62. Knobil K, Becker F, Harper P, Graf L, Wolf G, Martinez F. Dyspnea in a patient years after severe poliomyelitis. The role of cardiopulmonary exercise testing. Chest. 1994;105(3):777–81.

    CAS  PubMed  Google Scholar 

  63. Eliasson A, Phillips Y, Rajagopal K. Sensitivity and specificity of bronchial provocation testing. An evaluation of four techniques in exercise-induced bronchospasm. Chest. 1992;102:347–55.

    CAS  PubMed  Google Scholar 

  64. Johnson BD, Weisman IM, Zeballos RJ, Beck KC. Emerging concepts in the evaluation of ventilatory limitation during exercise: the exercise tidal flow-volume loop. Chest. 1999;116(2):488–503.

    CAS  PubMed  Google Scholar 

  65. Morris MJ, Deal LE, Bean DR, Grbach VX, Morgan JA. Vocal cord dysfunction in patients with exertional dyspnea. Chest. 1999;116(6):1676–82.

    CAS  PubMed  Google Scholar 

  66. Messner-Pellenc P, Ximenes C, Brasileiro CF, Mercier J, Grolleau R, Prefaut CG. Cardiopulmonary exercise testing. Determinants of dyspnea due to cardiac or pulmonary limitation. Chest. 1994;106(2):354–60.

    CAS  PubMed  Google Scholar 

  67. Palange P, Carlone S, Forte S, Galassetti P, Serra P. Cardiopulmonary exercise testing in the evaluation of patients with ventilatory vs circulatory causes of reduced exercise tolerance. Chest. 1994;105(4):1122–6.

    CAS  PubMed  Google Scholar 

  68. Millar L, Sharma S. Dyspnoea: focus on heart failure. In: Kaski J, Papadakis M, Raju H, editors. Investigating and managing common cardiovascular conditions. London: Springer; 2015.

    Google Scholar 

  69. Martinez F. Evaluation of dyspnea. Educational review manual in pulmonary diseasee. New York: Castle Connolly Graduate Medical Publishing, Ltd.; 2003.

    Google Scholar 

  70. Sietsema K. Approach to the patient with dyspnea. In: Humes HD, editor. Kelley’s textbook of medicine. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2000.

    Google Scholar 

  71. The Criteria Committee of the New York Heart Association. Nomenclature and criteria for diagnosis of diseases of the heart and great vessels. 9th ed. Boston: Little Brown; 1994. p. 253–6.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Fernando J. Martinez .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Martinez, F.J., Han, M.L.K., Aaronson, K.D. (2020). Dyspnea. In: Baliga, R., Eagle, K. (eds) Practical Cardiology. Springer, Cham. https://doi.org/10.1007/978-3-030-28328-5_2

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-28328-5_2

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-28326-1

  • Online ISBN: 978-3-030-28328-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics