Lack of breath or dyspnea, a symptom that we can imagine as a “container” that can fill up in relation to the presence of various pathologies – he explains Massimo Mapelli, of the Decompensation and Clinical Cardiology Unit of the Monzino Cardiology Center and University of Milan -. Fortunately, after investigating the patient’s clinical history and evaluating the symptoms, many diagnostic tools come to our aid to understand which “tap” is leaking the most and which needs to be corrected.
Visit and instrumental checks
What are the exams you rely on?
After the patient’s medical history and the visit in search of clinical signs, the electrocardiogram is the most common examination in the cardiology field. It records and displays the electrical activity of the heart and, by monitoring it, allows to identify signs of heart disease or arrhythmias. To the electrocardiogram is added the echocardiogram, based on the use of very sophisticated ultrasound, which allows you to see “from the inside” both the walls of the heart and the finer structures (such as valves) and to evaluate contractility with greater precision. . In some cases, a simple blood test is sufficient to determine a specific marker (called Bnp) whose presence, together with specific symptoms, suggests the presence of heart failure or decompensation. Coronarography and coronary CT scan then allow to evaluate the state of health of the coronary arteries which, if compromised, can cause dyspnea.
The stress test
Can a cardiopulmonary exercise test also be useful?
fundamental because he studies the subject not when he is standing still, lying on a hospital bed, but how he behaves in real life, on the move. At the same time, cardiac, pulmonary and muscular work is evaluated, going beyond the observation of the electrocardiogram alone. a particularly useful examination precisely in patients with breathlessness of unspecified origin, in which it is necessary to identify which “tap” contributes most to filling the “dyspnea” container.
The cause
What can be the cardiological causes of shortness of breath?
Let’s start with heart failure, which can be acute, caused by the presence of water in the lungs, or chronic and that is adaptive (at the origin there is the inability of the heart to perform the normal contractile pump function and to guarantee a correct blood supply. to all organs). Also valvulopathies such as aortic stenosis and mitral insufficiency, arrhythmias (among which the most frequent without a doubt atrial fibrillation), or ischemic heart disease even without reaching the heart attack, are frequent causes of shortness of breath. Less frequently, other particular conditions such as hypertrophic heart disease can cause shortness of breath and as well, perhaps less known, amyloidosis. a typical pathology mostly of the elderly, less rare than is believed. In this case an abnormal protein to accumulate in various tissues, forming deposits, and damaging them. Buildups can occur in the kidney, brain but also heart making it stiff, thickened, resembling a piece of plastic.
Chest pain
Is there any way to understand, albeit roughly, if the cause of the pulmonary or cardiological shortness of breath? Could the concomitant presence of chest pain constitute a discrimination?
The dyspnoic symptomatology alone is unfortunately very nonspecific and, if verified, it requires at least some investigation to understand the cause. The concomitant presence of chest pain, especially if of an oppressive nature behind the breastbone, perhaps associated with physical exertion, can point towards a heart problem. However, more typically pulmonary causes – such as pneumothorax or pulmonary embolism – also present in a similar fashion, which can be confusing.
How to behave
At the first suspicious symptoms, especially if you have never suffered from these disorders in the past, it is advisable to contact your doctor and then eventually to a specialist. If the disorders are acute and very intense even at 118. The high frequency of pulmonary and cardiovascular diseases, as well as some common risk factors that favor the onset (cigarette smoking, obesity) make the coexistence of both conditions very frequent with summation effect on shortness of breath.
June 5, 2021 (change June 5, 2021 | 19:13)
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