lung and airway disorders
Shortness of Breath
Evaluation of Shortness of Breath
The following information can help people decide whether a doctor's evaluation is needed and help them know what to expect during the evaluation. In people with dyspnea, the following symptoms are of particular concern: Shortness of breath at rest Agitation or confusion or a decreased level of consciousness Chest discomfort or the feeling the heart is pounding or racing or has skipped a beat (palpitations) Weight loss Night sweats People who have shortness of breath at rest, chest pain, palpitations, agitation, confusion or a decreased level of consciousness or have difficulty moving air in or out of their lungs should go to the hospital right away. Such people may need immediate testing, treatment, and sometimes admission to the hospital. Other people should call a doctor. The doctor can determine how rapidly they need to be evaluated based on the nature and severity of their symptoms, their age, and any underlying medical conditions. Typically, they should be evaluated within a few days. Doctors first ask questions about the person's symptoms and medical history. Doctors then do a physical examination. What doctors find during the history and physical examination often suggests a cause and the tests that may need to be done (see table). Doctors ask questions to determine When shortness of breath started Whether it started abruptly or gradually How long the person has felt short of breath Whether any conditions (such as cold, exertion, exposure to allergens, or lying down) trigger it or make it worse The person is also asked questions about past medical history (including any lung or heart disorders), a history of smoking, any family members who have had high blood pressure or high cholesterol levels, and risk factors for pulmonary embolism (such as recent hospitalization, surgery, or long-distance travel). The physical examination focuses on the heart and lungs. Doctors listen to the lungs for congestion, wheezing, and abnormal sounds called crackles. They listen to the heart for murmurs (suggesting a heart valve disorder). Swelling of both legs suggests heart failure, but swelling of only one leg is more likely to result from a blood clot in the leg. A blood clot in the leg may break off and travel to the blood vessels in the lungs, causing pulmonary embolism. To help determine the severity of the problem, doctors measure oxygen levels in the blood with a sensor placed on a finger (pulse oximetry). Typically, they also take a chest x-ray unless the person clearly appears to be having a mild flare-up of an already diagnosed chronic disorder such as asthma or heart failure. The chest x-ray can show evidence of a collapsed lung, pneumonia, and many other lung and heart abnormalities. For most adults, Electrocardiography (ECG) is done to check for inadequate blood flow to the heart. ). Tests to evaluate how well the lungs are functioning ( Pulmonary Function Testing (PFT) ) are done when the doctor's examination suggests a lung disorder but the chest x-ray does not provide a diagnosis. Pulmonary function tests can measure the degree of restriction or obstruction and the ability of the lungs to transport oxygen from the air to the blood. A lung problem may include restrictive and obstructive abnormalities as well as abnormal oxygen transport. For people at moderate or high risk of pulmonary embolism, specialized imaging tests, such as CT angiography or ventilation/perfusion scanning, are done. For people at low risk of pulmonary embolism, a D-dimer test may be done. This blood test helps identify or rule out a blood clot. Other tests may be necessary to diagnose and further evaluate anemia, heart problems, and certain specific lung problems. 