Shortness of breath in heart failure

Author Ольга Кияница


The development of heart failure is mainly accompanied by the appearance of a symptom such as shortness of breath. Depending on its severity, the patient's condition may be disturbed to a greater or lesser extent. The occurrence of shortness of breath often indicates the progression of the underlying disease and the need for emergency medical treatment.

Heart failure (HF) is a clinically unfavorable syndrome that often develops against the background of other pathologies of the cardiovascular system. There are various symptoms of HF, but one of the first is shortness of breath. Its appearance is often associated with the deterioration of the patient.

Shortness of breath, or dyspnea , is confused breathing, which may be accompanied by pain while breathing. May occur in both heart and lung diseases.

When dyspnea occurs, it is necessary to find out the cause of its occurrence. If heart failure has already been established, then the appearance of difficulty breathing may require correction of treatment. If necessary, additional research methods in the form of ultrasound of the heart and electrocardiography are conducted.

Video: Why does shortness of breath occur in heart failure?

Dyspnea description

Shortness of breath is when a person feels that it is difficult for him to get enough air into his lungs. This may signal a serious health problem. Sometimes the feeling worsens when the person is physically active or when he goes to bed. In addition, other symptoms, such as cough or fever, may be detected.

If you experience any of these symptoms, you should immediately inform your doctor. If dyspnea occurs suddenly or is extremely severe, accompanied by chest pain, you should call an ambulance.

Symptoms of shortness of breath

When a person has shortness of breath, it seems to him that he cannot take a breath. It may also not be possible to breathe deeply. Sometimes there is compression or pressure in the chest.

Depending on the course and individual characteristics of the patient's sensation, which one has to experience, a person can express as:

  • “Not enough breathing.”
  • "Tightness in the chest."
  • “It’s impossible to get enough air.”

If there are concomitant diseases, then their manifestations complement the clinical picture of heart failure.

Forms of dyspnea

Dyspnea is a symptom most commonly reported by patients with heart failure and / or pulmonary disease. It is also determined in obese and elderly people. The following types of dyspnea exist:

  • Emergency - develops against the background of acute conditions, including acute heart failure, when, under the influence of traumatic, intoxication and other factors, the heart abruptly stops pumping blood properly.
  • Orthopnea is a pronounced breathing disorder that does not allow the patient to be in a lying state, therefore, he is either sedentary or vertical.
  • Paroxysmal nocturnal dyspnea - characterized by the development of confused breathing during a night's sleep, because of which the patient wakes up. This condition is threatened by complete cessation of breathing (apnea).
  • Bendopnoe - respiratory failure occurs when bending forward. The appearance of this symptom is believed to indicate the presence of extremely severe heart failure.

Bendopnoye is a new term that was first used in 2014 by American researchers who measured heart pressure and ejection volumes in patients with systolic heart failure in different positions. In patients with Bendopnia, higher pressure was registered in the right atrium and pulmonary vessels.

Classification of dyspnea by severity according to the version of the American Thoracic Society.

Description Graduation Degree of shortness of breath
Lack of shortness of breath when climbing up steps 0 Absent
Dyspnea occurs when lifting up 1 Average
Walking becomes slower than other people of the same age. When climbing a ladder at the same pace, shortness of breath occurs 2 Pronounced
When walking a short distance, a person needs to stop to recover his breath. 3 Heavy
Dyspnea becomes a little irregular, even when the patient is at home, changing his clothes or other household activities, dyspnea occurs. 4 Very heavy

Causes of Dyspnea in Heart Failure

Like most of the symptoms that people experience with heart failure, a feeling of shortness of breath is a result of the fact that the heart pumps blood less efficiently throughout the body. In particular, as the myocardium is weakened or overloaded, it becomes less able to pump blood entering the heart and leaving it at the right pace. This can lead to blood accumulating or "stagnating" in the vessels that go from the lungs to the heart. If this happens, blood plasma can leak and accumulate in the lungs. [1 - Medline Plus. Pulmonary edema. Available here: Last accessed November 2016]

The human lungs are a complex organ that is necessary for removing carbon dioxide and exchanging it for oxygen. But this process takes place with violations, when fluid accumulates inside the lung tissue (in the alveoli). This is what leads people with heart failure to the fact that they lack air and breathing is defined as confused.

In addition, people suffering from impaired cardiac performance may feel more out of breath because fluid spreads over the surface of the lungs (similar to the fluid in a bottle that is upright and that spreads when the container turns over).


Dyspnea should be correctly diagnosed, since this symptom occurs not only in heart failure, but also in bronchial asthma, inflammatory-infectious diseases of the lungs, etc.

A doctor can help you find the cause of a breathing problem or, on the contrary, confirm the association of dyspnea with HF The first questions will be asked about symptoms, life history and the progress of the disease. Next is a physical examination. If necessary, the doctor uses laboratory tests and instrumental diagnostic methods.

When dyspnea on the background of heart failure can be involved:

  • Blood oxygen test , also known as blood gas test. During it, the amount of oxygen and carbon dioxide in the blood is measured. If there is an imbalance between these two components, it may mean that the lungs do not work well. For this study, a blood sample is taken not from a vein, as usual, but from an artery. This is because arterial blood has a higher level of oxygen than blood from a vein. The artery inside the wrist, called the radial artery, is commonly used for analysis. Sometimes a sample is taken from an artery near the elbow or in the groin area. If a newborn is tested, then the biomaterial is taken from the baby’s heel or the umbilical cord.
  • Chest X-ray . The test can be conducted in a doctor’s office, clinic, hospital or other medical facility. Before the study, you will need to strip to the waist, put on a robe and take off all the jewelry and objects that may prevent you from taking a good picture. Depending on the condition of the patient himself, the doctor may ask to stand, sit or lie still on a special table. To protect the reproductive organs from X-rays, a special lead apron is worn. Two types of images are usually taken: one in direct projection and the other in side, but more types of radiographs are needed. After the examination, the radiologist analyzes the images and draws his own conclusion, which is then sent to the attending physician.

A chest x-ray is a relatively safe diagnostic method. Although X-rays are used during its implementation, the radiation dose is still too small to cause harm to the subject.

  • Spirometry It is one of the most commonly used methods for diagnosing lung diseases. A spirometer measures the amount of inhaled and exhaled air. This test is performed in stages: first, take deep breaths, and then you can quickly.Air must be blown into a special tube connected to a medical device (spirometer). To get the most accurate result, the test is repeated three times. Between testing a little rest. This test usually takes 30 minutes to complete.
  • Electrocardiography (also called ECG) . During this method of diagnosis, you need to lie on the couch so that the heart is under the control of the ECG equipment. An image is created on the screen that shows the electrical signals of the heart.
  • Computed tomography (CT) . It is a more advanced prototype x-ray study. During testing, the doctor can measure the power of breathing with a spirometer and the level of oxygen in the blood.

Ways to eliminate shortness of breath

  • First you need to maintain physical activity. If the feeling of difficult breathing occurs only during training, then you need to learn to recognize when the symptoms begin, and next time to stop at the first signs of their appearance. It is known that regular physical exercise within reasonable limits improves the functioning of the heart, so it is useful to find a level of activity that can be maintained.
  • If necessary, talk to your doctor about the selection of suitable exercises and physical exercises. In general, movement exercises have a much better effect on the circulatory system than weight training. Therefore, quiet cycling, walking or swimming are usually normally perceived; whereas weight lifting or power loading is often less effective, and sometimes even harmful to health.
  • If shortness of breath occurs when performing daily tasks, for example, while climbing stairs or taking a shower, you should talk to your doctor or other specialists who can help restore breathing and, if necessary, adjust the treatment.In addition, in difficult times, you need to try so that your relatives or friends can provide support, because help in daily activities can give the patient the opportunity to feel more confident in their abilities.
  • If dyspnea occurs during rest, you should consult with your doctor or specialized experts on how to manage this condition, as it may be necessary to adjust the current treatment regimen.
  • If you feel short of breath in the prone position, you can put a few pillows so that the body is in a semi-vertical position.

Prevention of heart failure and shortness of breath

There are many things that can increase the risk of heart disease, including heart failure. They are called risk factors.Some of them can not be controlled, but there are those who really manage. The elimination of these risk factors will reduce the likelihood of heart disease.

Risk factors for heart disease that are impossible or problematic to change:

  • Age The appearance of heart failure, as well as other heart diseases, depends on the age of the person. Men at the age of 45 and older and women at the age of 55 and older are at greater risk.
  • Paul Some risk factors may have different effects on the occurrence of heart disease in women and men. It is proved that estrogen provides women with some protection against heart disease, so before the menopausal period, they suffer less. But diabetes increases the risk of heart disease in women more than men.
  • Race or ethnicity. Some nations have a greater propensity for heart disease than others. For example, African Americans are more likely than whites to suffer from heart disease, while Latin American Americans are less likely to have heart disease. Some Asian nationalities, such as East Asians, are less likely to suffer from impaired cardiac activity compared to southern Asians.
  • Genetic predisposition . The risk of HF increases substantially if close relatives have the same disease or other heart disease.

These risk factors are extremely difficult or virtually impossible to control, whereas there are those circumstances that can be influenced to improve health. Given them, you can use a number of recommendations for the prevention of heart failure, and with it - shortness of breath.

  • It is important to control your blood pressure. High blood pressure is a major factor in the development of heart failure. It is necessary to regularly check the level of blood pressure - at least once a year for most adults, and more often, especially in the presence of hypertension. Measures must be taken, including lifestyle changes, to prevent or control high blood pressure.
  • Keep cholesterol and triglycerides within acceptable limits. Elevated cholesterol can block arteries and increase the risk of coronary heart disease, heart attack, and heart failure. Changes in lifestyle and medication (if necessary) can reduce cholesterol levels. Triglycerides are another type of fat in the blood. The high level of these substances increases the risk of coronary artery disease, especially in women.
  • It should maintain a healthy weight. Overweight or obesity can increase the risk of heart disease. This is due to the fact that other risk factors for heart disease are involved, including high blood cholesterol and triglycerides, hypertension and diabetes. Weight control can reduce the possibility of CH and shortness of breath.
  • Need to adhere to the proper diet . It is worth trying to limit the intake of saturated fats, foods high in sodium and sugar. It is better to eat a lot of fresh fruits, vegetables and whole grains. The DASH diet is an exemplary nutritional plan for people who want to lower blood pressure and cholesterol. This in turn can reduce the risk of shortness of breath arising against the background of heart failure.
  • Train regularly. Exercise has many benefits, including strengthening the heart and improving blood circulation. It can also help maintain a healthy weight and lower cholesterol and blood pressure. In general, the risk of heart disease is reduced.
  • Be sure to give up alcohol. Drinking too much alcohol can raise blood pressure. It also increases the load of additional calories, which can cause weight gain, and ultimately - the load on the heart and heart failure. Due to these risks, men can consume no more than two alcoholic beverages per day, and women - no more than one.
  • Stop smoking . Nicotine and nicotine-like substances increase blood pressure and the risk of heart attack, stroke, heart failure. If you do not have the habit of smoking, then you should not start. If you have bad habits you need to not give up, which will help reduce the risk of heart disease. Today, there are various ways to stop smoking, some of them can be advised by the attending physician.
  • Control stressful situations. Stress is directly related to heart disease in many ways. Psycho-emotional stress can raise blood pressure. Often, extreme situations become a “trigger” for a heart attack. In addition, some common ways to cope with stress, such as overeating, drinking alcohol and smoking, are harmful to the heart. Other methods to cope with stress include exercise, listening to music, focusing on something calm or peaceful, and meditation.
  • Treatment of major diseases . Heart failure mainly develops against the background of other diseases of the heart, blood vessels and endocrine disorders. Therefore, diseases such as diabetes, thyrotoxicosis, arrhythmias, heart defects, etc. must be kept under control. This will significantly reduce the likelihood of CH.

Finally, we should point out that in order to reduce the risk of dyspnea in heart failure, you need to rest and sleep enough. If a person does not get enough sleep, the risk of high blood pressure, obesity and diabetes increases. These three diseases primarily contribute to the development of heart disease. Most adults need 7 to 9 hours of sleep per day.

Key points

  • Dyspnea is a serious symptom that cannot be ignored.
  • The development of dyspnea is associated with the accumulation of fluid in the lungs, which stagnates in the small circle of blood circulation against the background of impaired heart function.
  • The treatment of dyspnea is associated with a medical effect on the underlying disease - heart failure.
  • Prevent the development of dyspnea can be typical methods of prevention of cardiovascular diseases, among which are modifiable and not amenable to change.

Video: How to treat shortness of breath and heart failure

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