Symptoms — Cardiac Investigation
Breathlessness &
Shortness of Breath
Breathlessness — medically termed dyspnoea — is a subjective sensation of breathing discomfort. It is one of the most common reasons for cardiology referral and can arise from both cardiac and respiratory causes, many of which are treatable.
Understanding the Symptom
What Is Breathlessness?
Breathlessness is defined as a subjective experience of discomfort during breathing. It is a symptom — not a diagnosis — and the underlying cause must be identified before appropriate treatment can be prescribed.
Presentations vary widely. Some patients feel an inability to take a satisfying breath; others experience shallow rapid breathing, a sensation of air hunger, or a feeling that their chest will not fully expand. The symptom can be acute — developing over hours or days — or chronic, persisting over weeks to months.
As a cardiologist, Dr Nijjer investigates whether the breathlessness arises from a cardiac source — the heart's inability to pump efficiently, abnormal rhythm, or insufficient blood supply — while working alongside respiratory physicians when a lung cause is suspected.
Differential Diagnosis
Cardiac vs Respiratory Causes
Identifying whether the cause is cardiac or respiratory — or a combination of both — is the key first step in investigation. Many patients have contributing factors from both systems.
Investigated by Dr Nijjer
Cardiac Causes
- Heart Failure — the heart cannot pump enough blood to meet the body's demands, causing fluid to back up into the lungs
- Coronary Heart Disease & Ischaemia — insufficient blood supply to the heart muscle during exertion
- Arrhythmias — atrial fibrillation, fast or slow heart rhythms that reduce pumping efficiency
- Valve Disease — narrowed or leaking heart valves that impede normal blood flow
- Pericardial Disease — fluid around the heart compressing the chambers
- Severe Anaemia — insufficient oxygen-carrying capacity reducing cardiac output
Respiratory / Other
Non-Cardiac Causes
- COPD — chronic obstructive pulmonary disease causing progressive airflow limitation
- Asthma — reversible airway narrowing triggered by allergens or irritants
- Pneumonia — lung infection reducing the available surface for gas exchange
- Pulmonary Fibrosis — progressive scarring of lung tissue
- Pleural Effusion — fluid around the lung compressing lung tissue
- Deconditioning — reduced cardiovascular fitness from prolonged inactivity
Onset & Duration
Acute vs Chronic Breathlessness
The speed of onset gives important diagnostic information and helps direct the urgency and type of investigation required.
Acute Breathlessness
Rapid-onset breathlessness — developing within hours — may indicate acute heart failure, a pulmonary embolism (blood clot in the lung), severe asthma, or pneumonia. This warrants prompt hospital assessment, as some causes are life-threatening without rapid treatment.
Chronic Breathlessness
Gradual onset over weeks or months suggests a progressive condition — heart failure, COPD, pulmonary fibrosis, or anaemia. Dr Nijjer investigates these systematically to establish the primary cause before planning treatment.
Investigation
Tests for Breathlessness
A structured set of investigations is used to identify whether the cause is cardiac, respiratory, or a combination of both. Dr Nijjer tailors the sequence to each patient's presentation.
ECG
Identifies arrhythmias, signs of heart muscle damage, or electrical conduction problems that could contribute to breathlessness.
Echocardiogram
Ultrasound of the heart — assesses pumping function, valve appearance, and whether fluid has accumulated around the heart.
Chest X-Ray
Identifies fluid on the lungs, heart enlargement, pneumonia, or lung collapse.
Blood Tests
Checks for anaemia, thyroid disease, BNP (a heart failure marker), and inflammatory markers.
Lung Function Tests
Spirometry measures airflow and identifies obstructive (asthma, COPD) or restrictive (fibrosis) lung patterns.
Exercise Stress Testing
Assesses breathlessness that occurs only on exertion and may reveal hidden ischaemia or impaired cardiac reserve.
Management
Treatment & Management
Treatment is directed entirely at the underlying cause, which is why accurate diagnosis is the essential first step. There is no single treatment for breathlessness — the correct approach depends entirely on whether the cause is cardiac, respiratory, or systemic.
For cardiac causes, this may include heart failure medications, correction of an arrhythmia, valve intervention, or coronary angioplasty to restore blood supply to an ischaemic region of heart muscle.
For respiratory causes, treatment may involve inhalers, steroids, antibiotics, pulmonary rehabilitation, or smoking cessation programmes.
For deconditioning — increasingly common following periods of illness or inactivity — a structured graded exercise programme can produce dramatic improvements in breathlessness and quality of life.
Related Conditions
Further Reading
Concerned about breathlessness?
Dr Nijjer offers expert assessment of breathlessness at 68 Harley Street, combining cardiac and respiratory investigations to identify the cause and plan the most effective treatment.