Causes of dyspnea

Since shortness of breath, or dyspnea, is not always a consequence of pathological processes in the body, it is divided into a physiological and pathological variant. Thus, physiological dyspnea is a conventional compensatory mechanism that is triggered when there is a forced oxygen deficiency-for example, excessive physical overload. But the pathological variant of dyspnea is the result of painful processes. For example, dyspnea may manifest itself in diseases of the cardiovascular system, respiratory tracts, etc.

The most common causes of dyspnea:

• cardiac asthma and pulmonary edema,
• pulmonary embolism,
• spontaneous pneumothorax,
• bronchial asthma,
• psychogenic causes.

Psychogenic causes

Some people may have attacks of psychogenic dyspnea. In these cases, for unknown reasons, there is a feeling of lack of air, not associated with heart failure. As a rule, dyspnea is preceded by a feeling of unmotivated anxiety or fear. The patient begins to breathe deeper and more often, but the thorax does not seem to be able to expand enough to take a deep breath. As a result, a feeling of lack of air and shortness of breath increases, dizziness is often noted, and in some patients there may even be a pre-patchy condition. This dyspnea is usually called a hyperventilation syndrome. Psychogenic dyspnea itself is safe. In a mild form, such attacks during excitement or anxiety are experienced by many healthy people. Usually in the form of the inability to breathe as deeply as you want, or simply in the form of involuntary sighs.

From clinical and pathogenetic positions, psychogenic dyspnea should be distinguished from hyperventilation syndrome, in which it can be one of the leading manifestations. The presence of difficulty (subjective) breathing usually causes a desire to get rid of shortness of breath by increasing breathing, which, as a rule, increases the feeling of respiratory discomfort. Consequently, the relationship between psychogenic dyspnea and hyperventilation is very tight, and only the duration of the phenomenon of dyspnea and its severity can play a role in whether it is combined with compensatory hyperventilation or with already developed hyperventilation syndrome - a sufficiently deep and multidimensional, persistent pathological condition.

Apparently, psychogenic dyspnea in a "pure" form (i.e., without concomitant hyperventilation) is rare. Nevertheless, in the presence of respiratory discomfort at rest in a patient without changes in the organic nature in the nervous and somatic (including pulmonary) spheres with calm breathing, without signs of hypocapnia and alkalosis of blood, the diagnosis of psychogenic dyspnea is quite legitimate.

Pathological causes

Dyspnoea usually begins on a background of physical exertion, which is characteristic of the early stages of various diseases, when easily performed earlier loads gradually become less tolerable.

The symptom of dyspnea is often associated primarily with pulmonary diseases, although this clinical symptom with about the same frequency occurs with heart disease. In addition, dyspnea may occur with obesity, severe anemia, intoxication, and also have a psychogenic nature (for example, in hysteria - in this case it is more appropriate to talk about hyperventilation). Consequently, if the patient complains of shortness of breath, first of all it is necessary to find out, with the pathology of which system it is mainly connected.

When exercise is of sufficient intensity, dyspnea occurs in healthy people. Such a feeling of shortness of breath during exercise is familiar to everyone. With heart disease, dyspnea begins to appear even with normal daily exercise, causing the patient to move at a slower pace.

The most common cause of dyspnea with exercise is the lack of training. All people sooner or later have shortness of breath when exercising, if not maintain physical fitness. 

The same shortness of breath is noted with obesity. Especially since obesity and detuneism often accompany each other. Shortness of breath can be a sign of lung disease. The most common cause of chronic persistent shortness of breath is emphysema.

In patients with severe heart damage with heart failure, due to left heart disease (left ventricular failure), dyspnoea attacks at rest are noted. Most often these are attacks of so-called paroxysmal nocturnal dyspnea. These seizures are often called cardiac asthma (during the attacks dry rales are heard, caused by swelling of the bronchi). In typical cases, the patient falls asleep, but after 2-5 hours wakes up due to a feeling of lack of air caused by venous stasis in the lungs. In the sitting position or when walking around the room, the attack passes through 30-45 minutes. If you take nitroglycerin - an attack of cardiac asthma passes faster. Patients with bouts of nighttime dyspnea, as a rule, can not stay in the prone position for a long time because of difficulty breathing, due to a rapid increase in venous stasis in the lungs. This state is called orthopnea. Patients with orthopnea instead of the prone position have to take a semi-sidereal position, for example, by using several pillows.

An extreme manifestation of heart failure is pulmonary edema. When swelling of the lungs there is a sensation of suffocation, there is pronounced dyspnea with a respiratory rate of more than 30 per minute, sweating. Patients can not be in a prone position and take a sitting or standing position (orthopnea), leaning on the edge or back of the bed. The wheezing in the lungs can be heard from a distance. In far-reaching cases there is a bubbling breath, coughing out pinkish foamy sputum.

Dyspnea with damage to the right heart (pulmonary artery thromboembolism and pulmonary heart, stenosis of the pulmonary artery valve, right ventricular infarction) and with cardiac tamponade, in most cases, is not accompanied by orthopnea, t. There is no venous congestion in the lungs. Patients, as a rule, can be in a prone position. There are only tachypnea (increased respiratory rate) and signs of venous congestion in a large circle of circulation. This is a very important difference from shortness of breath caused by left ventricular failure, with the defeat of the right heart is contraindicated the use of diuretics and vasodilators. And when hypotension is shown in / in the introduction of fluid.

The appearance of shortness of breath leads to the following diseases and pathological conditions.

1. Diseases of the respiratory system;
   • chronic obstructive bronchitis:
   • bronchial asthma;
   • Irritative bronchial obstruction (inhalation of vapors of acids and alkalis, chlorine, ammonia, hydrogen sulfide, nitrogen oxides and other substances, pollutants, as well as temperature effects on bronchial mucosa);
   • pneumonia;
   • acute bronchiolitis;
   • pulmonary tuberculosis, sarcoidosis;
   • silicosis;
   • pulmonary edema;
   • oncological injuries of the respiratory system;
   • non-oncological diseases leading to stenosis of the trachea, larynx (Quincke edema, viral infection with laryngeal stenosis, diphtheria croup, pharyngorecophalic abscess, foreign body, etc.);
   • atelectasis of the lungs:
   • emphysema of the lungs;
   • effusion pleurisy, empyema of the pleura, pneumothorax, hemothorax:
   • pneumomediastinum;
   • interstitial lung diseases, including rare diseases that can be diagnosed in pediatric practice (familial fibrocystic pulmonary dysplasia, idiopathic pulmonary hemosiderosis, alveolar pulmonary proteinosis), as well as systemic diseases (scleroderma, some variants of Bechterew's disease, rheumatoid polyarthritis, various pulmonary vasculitis ), ray of fibrosis of the lungs;
   • tracheobronchomegalia;
   • cystic fibrosis.
2. Cardiovascular diseases:
   • cardiac ischemia; myocarditis, cardiomyopathy, pericarditis, heart defects;
   • hypertonic disease;
   • exfoliating aortic aneurysm; thrombosis.
3. Diseases of the blood, in which the ability to bind oxygen and reduce it to organs and tissues decreases:
   • anemia of different etiology;
   • poisoning with carbon monoxide (carbon monoxide);
   • methemoglobinemia.
4. Defeat of respiratory musculature:
   • poliomyelitis (damage to the nerves innervating intercostal muscles, diaphragm and other groups of respiratory muscles):
   • myasthenia gravis;
   • dermatomyositis (when involved in the process of respiratory musculature);
   • poisoning with nicotine;
   • hypokalaemia;
   • postdipheteric paralysis of the respiratory muscles.
5. Dyspnoea of central origin (respiratory center depression):
   • overdose of funds for anesthesia, barbiturates, morphine;
   • uremia;
   • acidosis;
   • neoplasms of the brain;
   • cerebral hemorrhages, edema of the brain;
   • bulbar form of poliomyelitis; meningitis, encephalitis.
6. Endocrine disorders (thyroid gland diseases, obesity, hypoparathyroidism, hypothalamic pathology, Addison's disease).
7. Psychogenic dyspnea with neuroses, hysteria.
8. Pressure on the diaphragm from the side of the abdominal cavity (ascites, pronounced meteorism, etc.), kyphoscoliosis, age-related rigidity of the chest.
9. Fever of different genesis.

What else can be shortness of breath?

In addition, there is still the concept of atypical, transitory dyspnea: this type of dyspnea can be associated with the use of certain medications or substances. At the end of the treatment, the respiratory rhythm is restored.

• Dyspnea with acute bronchitis often signals the possible development of complications in the form of pneumonia or pleurisy, or about the transition of an acute process to a chronic one. From shortness of breath in bronchitis should distinguish paroxysmal suffocation - this is particularly difficult breathing, which is often triggered by blockage of the bronchial lumen viscous dense sputum, which, in turn, leads to stenosis and even deformation of the branch of the bronchi. This situation is typical for obstructive bronchitis - on an elongated exhalation the patient issues a specific "whistle", which can be heard even remotely.
• Dyspnea from allergies appears immediately after exposure to the allergen on the patient's body. The course of such shortness of breath is paroxysmal, with a different course - from mild to severe and dangerous. Treatment of such dyspnea may not lead to a positive result, if the allergen that caused the reaction is not eliminated.
• Dyspnoea from smoking can happen, as a novice smoker, and a person "with experience". Complication is associated with spasm of the bronchial lumen, which leads to difficulties with breathing. To avoid such shortness of breath lead to the development of bronchial asthma in the course of time, one should not only look for good remedies for dyspnea, but also think about abandoning the addiction.
• Shortness of breath from osteochondrosis appears when the location of the thoracic vertebrae is disturbed, while nerve fibers and blood vessels are infringed. With such violations, oxygen deficiency occurs: the body includes a compensation regime, in which the frequency and depth of breathing changes. The patient thus feels a lack of air, tries to take a deep breath - at this moment, as a rule, there is pain in the broken zone of the thoracic spine.
• Dyspnea from the nerves in another way is called a respiratory neurosis. The reason for this phenomenon is not always hidden in the presence of frequent stresses or experiences, but the psychological factor here plays a major role.
• Shortness of breath from antibiotics and other medications is a very common phenomenon. Such a reaction is considered a frequent side effect of the administration of antibiotics, sulfonamide drugs, many cardiotonic and neurological medicines. More rarely dyspnea is caused by non-steroidal anti-inflammatory and antihistamines - especially in people prone to drug hypersensitivity. The mechanism of development of such a type of dyspnea consists in the fact that many medications lead to the accumulation of bronchial secretion, which, against weakness and low immunity, provokes a difficulty in breathing.
• Dyspnea from Flebodia is a very rare phenomenon that can occur only in people prone to hypersensitivity. Flebodia is a preparation of diosmin, related to angioprotective and capillary stabilizing agents. Flebodia is considered a modern medicine, which rarely causes the development of side effects and is well perceived by most patients.
• Dyspnea from Prednisolon is found only in isolated cases - it often happens on the contrary: Prednisolone is prescribed to eliminate problems with the respiratory system. However, it is impossible to exclude the possibility of hypersensitivity development - this condition can happen in any patient.
• Dyspnoea from physical exertion is a normal reaction of an organism that has not previously been subjected to training. In particular, dyspnea often occurs in those who previously led a sedentary lifestyle. If you exercise regularly, over time, problems with breathing during exercise will disappear on your own.
• Dyspnoea from coffee can happen due to the fact that caffeine increases blood pressure and stimulates heart activity. However, this side effect does not happen in all coffee lovers - in some people coffee, on the contrary, can relieve a shortness of breath. Therefore, you need to listen carefully to your body: if coffee causes any unpleasant symptoms, then the drink should be discarded. Some experts believe that dyspnea can cause only a soluble drink, and quality brewed coffee does not have such an effect.
• Dyspnoea with smoking cessation often causes concern for people. With what is it connected? In fact, nothing terrible happens: just the lungs are cleaned and rebuilt to a new, healthy mode of operation. Dispnoea can continue throughout the period of cleansing, which usually lasts about six months. However, in order to avoid negative consequences, it is better to undergo respiratory diagnostics.
• Shortness of breath from beer or other alcoholic beverages is not a rare phenomenon. Even a single use of alcohol can disrupt the work of the heart for several days - it affects myocardial nutrition, the frequency of cardiac activity increases, the vessels narrow, the blood condenses. As a result, oxygen deficiency in the heart, which over time can develop into cardiovascular failure.

What makes shortness of breath at the slightest load?

Faults from the heart often at first do not attract attention. But many people have the first "bell" is just shortness of breath, and even with little physical activity, or at rest. Most heart and vascular diseases manifest as shortness of breath, but you need to listen carefully to your body: are there any other painful symptoms?

• With heart failure, shortness of breath with little physical activity is accompanied by a frequent feeling of fatigue, weakness. Additionally, dizziness and periodic tingling in the heart area may be of concern.
• With hypertension, dyspnea is associated with an excessive load on the heart due to increased blood pressure. The condition can be aggravated by a feeling of fatigue, pain in the back of the head or the whole head, ringing in the ears.
• The pre-infarction state proceeds not only with shortness of breath, but also with increased heart rate, a release of cold sweat, an inner sense of fear.
• Myocardial ischemia can occur with marked signs of nausea, sweating. Dyspnoea at the same time combined with a pressing feeling behind the sternum.
• Violations of the heart rate may be different, but often they are accompanied by a feeling of "jumping out" of the heart, shortness of breath, pronounced weakness, clouding of consciousness.
• The prolapse of the mitral valve often provokes general weakness, dizziness, shortness of breath, a feeling of a full chest.
• Asthma of the heart is accompanied by severe paroxysmal dyspnoea, cyanotic skin, increased sweating.

If dyspnea is associated with cardiac problems, then taking the appropriate medication to normalize the heart will necessarily lead to a softening and further disappearance of signs of respiratory failure.

What causes dyspnoea when walking?

Shortness of breath, which appears regularly on walking, in many cases is associated with malfunctions in the respiratory, cardiac and vascular systems. Deterioration of breathing increases gradually, the frequency of breathing becomes confused, the skin becomes pale, and the lips turn blue.

But this condition is not always associated with illness. If a person has a low-activity lifestyle, does not move enough, spends a lot of time sitting at the monitor of a computer or television, then his body simply "has lost the habit" of loads. Even walking can become a kind of "overload" for such a person. Especially often the "hypodynamic" dyspnea occurs when the step is accelerated, as well as when climbing the stairs.

If dyspnea during walking disturbs only in the cold season - and this happens often enough, then such pathological conditions as anemia, delayed metabolism, allergic processes can become the cause. In this situation, you can advise nutrition, taking multivitamin preparations, as well as the practice of proper breathing, to optimize pulmonary ventilation.

Shortness of breath from walking during pregnancy

Dispnoea in pregnant women is more often observed in the second half of pregnancy and usually has a physiological explanation.

So, dyspnea can arise as an adaptive mechanism - after all, the body of a pregnant woman requires more oxygen because of increased blood circulation.

Hormonal permutations are also important. For example, progesterone - an extremely important hormone, both for conception and for maintaining a pregnancy, activates the center of respiration in the brain, which leads to an expansion of the ventilation of the lungs.

The fetus develops and grows, at the same time the size of the uterus increases, which eventually begins to put pressure on closely located organs. Closer to the third trimester, the uterus begins to put pressure on the diaphragm, which in most cases provokes shortness of breath. Such shortness of breath is mixed - that is, it is equally difficult to inhale and exhale. By the way, when the uterus drops a little - and it happens about ½-1 month before the birth, it becomes easier to breathe.

The listed reasons are considered physiological, and do not require additional medical intervention. The only recommendations are rest, yoga and respiratory gymnastics, as well as the prevention of obesity.

However, we should not reject the possibility of pathology. The reasons listed below require a compulsory doctor's consultation, you can not ignore them:

• lowered hemoglobin level (oxygen transport to tissues worsens);
• Atherosclerosis of vessels, as a consequence of illness or smoking;
• frequent or severe stress;
• Respiratory diseases (pneumonia, bronchitis, obstructive bronchitis, asthma);
• heart disease and blood vessels (cardiopathy, ischemic heart disease, heart defects).

If the problem with breathing is accompanied by other painful symptoms (temperature, cough, dizziness, headaches, etc.), then in any case it is necessary to consult a doctor.

From what does the baby have shortness of breath?

Dyspnoea in a child often appears for the same reasons that it occurs in adult patients. However, due to the special hypersensitivity of the children's respiratory system, such factors as fright, physical overload, high temperature, high temperature in the room, etc., are quite capable of influencing the appearance of the problem.

Do not try to determine the cause of the violation yourself: this should be done by a pediatrician, since not always such a reason is innocuous. Difficulties with breathing in a child often cause such conditions:

• allergic reaction;
• coryza;
• asthma;
• influenza, ARVI, adenovirus infection;
• heart or lung disease;
• inhalation of a foreign object (this condition refers to extreme and requires urgent medical care);
• stressful situations, diseases of the nervous system (the so-called hyperventilation syndrome);
• overweight;
• genetic pathology of the respiratory system (eg, cystic fibrosis);
• hormonal and immune disorders.

In children, complications develop much more rapidly than in adults. Therefore, after the detection of respiratory problems, the child should immediately seek medical help without delay. The doctor will determine the cause and prescribe the main treatment and the appropriate remedy for dyspnea.