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Shortness of Breath & Anxiety: 10 Shortness of Breath Causes

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Last updated March 24, 2022

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Struggling to breathe can be a frightening experience. Symptoms of shortness of breath (dyspnea) vary in severity. Learn about 10 causes of shortness of breath.

9 most common causes

Asthma Attack
Iron Deficiency Anemia
COPD
Pneumonia
Bronchitis
Atrial Fibrillation
Illustration of various health care options.
Aortic Valve Regurgitation
Illustration of a doctor beside a bedridden patient.
Mitral valve prolapse
Illustration of a health care worker swabbing an individual.
Hypertrophic cardiomyopathy

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Shortness of breath symptoms

Struggling to breathe can be a frightening experience. The body depends on a constant flow of fresh air, and a problem that interferes with breathing is especially dangerous. Symptoms of shortness of breath, or dyspnea, can vary widely in severity. While sometimes shortness of breath symptoms are the result of an infection like pneumonia, the respiratory system may also be impacted or impaired by medical problems elsewhere in the body.

Common accompanying symptoms of shortness of breath

Shortness of breath symptoms may be associated with:

Causes of shortness of breath

Effective breathing depends on a complex network of systems in the body. Of course, the lungs must be healthy. However, the chest wall must be able to move freely and the windpipe, or trachea, needs to be clear. The brain controls breathing at a regular rate, and the heart pumps oxygen to the rest of the body. The surrounding air must also be clean and contain enough oxygen. As many body systems are involved in breathing, shortness of breath has a large number of causes that can be confusing. The following details may help you better understand your symptoms.

External causes

Illnesses or irritants in your environment can result in shortness of breath.

  • Infection: Viruses or bacteria can enter through the windpipe and cause problems like pneumonia.
  • Environment: Irritants in the air like pollution or pollen may cause inflammation in the airway and lungs, making it difficult to breathe.
  • Obstruction: Choking is when something physically blocks air from traveling through the windpipe. This is a special concern in young children.
  • Trauma: An accident or another injury may cause the lung to collapse or lead to painful injuries, like rib fractures, that make it difficult to breathe.
  • Toxins: Poisons like carbon monoxide or cigarette smoke may impair normal respiratory function.

Medical causes

Shortness of breath can be related to a medical condition.

  • Lung disease: Medical problems such as COPD or asthma may keep the body from getting enough oxygen.
  • Heart disease: Cardiac health is closely tied to the respiratory system, and problems like a heart attack or heart failure often cause shortness of breath symptoms.
  • Neurological disease: Nerves help power the muscles that inflate and deflate lungs, so without them, breathing would not be possible. Central nervous system conditions impacting the brain may also cause shortness of breath symptoms.
  • Hematologic disease: Blood disorders like a low blood count (anemia) or a tendency to form clots are serious concerns that may present with shortness of breath.

Other causes

Other causes that can result in shortness of breath include the following.

  • Anxiety: People who worry excessively often complain of shortness of breath, especially during stressful moments or panic attacks.
  • Poor overall fitness: Being overweight or out of shape increases stress on your body during physical activity.

This list does not constitute medical advice and may not accurately represent what you have.

Severe asthma attack

Asthma attack is also called asthma exacerbation. An attack causes the muscles of the airways to contract, the tissues to swell and produce mucus, and the bronchial tubes in the lungs to become narrow. This makes breathing very difficult.

Asthma is caused by an immune system that is too easily triggered by environmental factors, such as an upper respiratory infection (a cold or the flu;) tobacco smoke; dust; pets; cold air; and stress.

Most susceptible are those with repeated attacks, since the constant inflammation tends to cause further episodes.

Symptoms include wheezing, coughing, severe shortness of breath, chest tightness, chest pain, and inability to speak due to breathlessness.

A severe asthma attack is a life-threatening medical emergency. If the symptoms do not quickly respond to treatment with a fast-acting (rescue) inhaler, take the patient to the emergency room or call 9-1-1.

Treatment involves preventing colds, getting flu shots, and working with the medical provider to create a written set of instructions for whenever an attack might break out.

Rarity: Common

Top Symptoms: being severely ill, shortness of breath at rest, wheezing, irritability, cough with dry or watery sputum

Symptoms that always occur with severe asthma attack: shortness of breath at rest, being severely ill

Urgency: Hospital emergency room

Mitral valve prolapse

Mitral valve prolapse (MVP) occurs when the valve between the heart's left upper chamber (left atrium) and the left lower chamber (left ventricle) doesn't close properly because the flaps of the valve are "floppy." Most people who have the condition are born with it.

Rarity: Uncommon

Top Symptoms: fatigue, anxiety, rib pain, shortness of breath, racing heart beat

Urgency: Primary care doctor

Iron deficiency anemia

Iron deficiency anemia means that the body does not have enough iron to form hemoglobin, the protein in red blood cells that carries oxygen throughout the body.

The condition is caused by:

  • Acute blood loss through injury, surgery, or childbirth.
  • Chronic blood loss through an ulcer, overuse of aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs,) or heavy menstrual periods.
  • Inability to absorb dietary iron due to intestinal surgery or disease, or interference from certain medications.
  • A diet low in iron-supplying foods.

Symptoms include fatigue, shortness of breath, lack of endurance, and chest pain with rapid and irregular heartbeat.

If not treated, iron deficiency anemia can lead to heart disease because the heart has to pump extra blood to get enough oxygen to the tissues. Developmental problems in children can also occur.

Diagnosis is made through physical examination and blood tests.

Treatment includes a diet higher in iron-rich foods, such as red meat and dark green leafy vegetables, along with iron supplements. Severe cases may require hospitalization for blood transfusion and/or intravenous iron therapy.

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Hypertrophic cardiomyopathy

Hypertrophic cardiomyopathy (HCM) means "abnormal thickening of the heart muscle." This can interfere with the heart's ability to pump blood.

Most often, an inherited genetic mutation causes HCM. However, aging, high blood pressure, diabetes, or thyroid disease can sometimes bring it about.

Many people have no symptoms at all. Some have unexplained chest pain, shortness of breath, fainting, or the feeling of rapid, fluttering heartbeat, because the abnormally thick heart muscle interferes with normal heartbeat and causes an arrhythmia. Take the patient to the emergency room or call 9-1-1.

Untreated hypertrophic cardiomyopathy can lead to serious heart disease and even sudden cardiac arrest and death, especially in people under age 30.

Diagnosis is made through echocardiogram; electrocardiogram; treadmill stress test; and/or cardiac MRI.

Treatment involves medication to relax the enlarged heart muscle and slow the rapid pulse. Surgery to remove some of the thickened muscle may be done, or a defibrillator may be implanted.

Anyone with a family history of HCM should ask their medical provider about screening for the disease, which involves regular echocardiography.

Rarity: Rare

Top Symptoms: fatigue, shortness of breath, dizziness, racing heart beat, shortness of breath on exertion

Urgency: Primary care doctor

Chronic obstructive pulmonary disease (COPD)

Chronic obstructive pulmonary disease (COPD) is a progressive inflammation of the lungs that makes breathing difficult. It is caused by long-term exposure to irritating gases and/or dust particles, most often cigarette smoke.

Symptoms may take years to develop. They include a chronic cough with mucus (sputum), wheezing, chest tightness, fatigue, constant colds, swollen ankles, and cyanosis (blue tinge to the lips and/or fingernails.) Depression is often a factor due to reduced quality of life.

Treatment is important because there is a greater risk of heart disease and lung cancer in COPD patients. Though the condition cannot be cured, it can be managed to reduce risks and allow good quality of life.

COPD is commonly misdiagnosed and so careful testing is done. Diagnosis is made through patient history; physical examination; lung function tests; blood tests; and chest x-ray or CT scan.

Treatment involves quitting smoking and avoiding exposure to other lung irritants; use of inhalers to ease symptoms; steroids; lung therapies; and getting influenza and pneumonia vaccines as recommended.

Rarity: Common

Top Symptoms: fatigue, cough and dyspnea related to smoking, cough, shortness of breath, trouble sleeping

Symptoms that always occur with chronic obstructive pulmonary disease (copd): cough and dyspnea related to smoking

Symptoms that never occur with chronic obstructive pulmonary disease (copd): rectal bleeding

Urgency: Primary care doctor

Bronchitis

Bronchitis is an inflammation of the bronchial tubes, the tiny airways in the lungs.

Acute bronchitis, or "chest cold," comes on suddenly and is caused by the same virus that causes the flu or the common cold. Chronic lasts at least three months and recurs over two years. It is caused by cigarette smoking and/or exposure to other pollutants.

Other risk factors are weakened immune system and gastric reflux (heartburn.)

Symptoms include cough with clear, greenish, or yellowish mucus; fatigue; mild headache; body aches; shortness of breath; low-grade fever; chest discomfort.

Acute bronchitis can lead to pneumonia. Chronic bronchitis is a form of chronic obstructive pulmonary disease (COPD) and requires medical treatment.

Diagnosis is made with chest x-ray and sputum test.

Acute bronchitis lasts 7 to 10 days and needs good supportive care – rest, fluids, and over-the-counter pain relievers. Antibiotics do not work against viral illness.

Chronic bronchitis is treated with lifestyle changes – especially smoking cessation – and an inhaler or other lung medication.

Flu shots, frequent handwashing, and not smoking are the best prevention.

Bacterial pneumonia

Bacterial pneumonia is an infection of the lungs caused by one of several different bacteria, often Streptococcus pneumoniae. Pneumonia is often contracted in hospitals or nursing homes.

Symptoms include fatigue, fever, chills, painful and difficult breathing, and cough that brings up mucus. Elderly patients may have low body temperature and confusion.

Pneumonia can be a medical emergency for very young children or those over age 65, as well as anyone with a weakened immune system or a chronic heart or lung condition.

Complications may include organ failure and respiratory failure. Take the patient to the emergency room or call 9-1-1.

Diagnosis is made through blood tests and chest x-ray.

With bacterial pneumonia, the treatment is antibiotics. Be sure to finish all the medication, even if you start to feel better. Hospitalization may be necessary for higher-risk cases.

Some types of bacterial pneumonia can be prevented through vaccination. Flu shots help, too, by preventing another illness from taking hold. Keep the immune system healthy through good diet and sleep habits, not smoking, and frequent handwashing.

Rarity: Common

Top Symptoms: fatigue, cough, headache, loss of appetite, shortness of breath

Symptoms that always occur with bacterial pneumonia: cough

Urgency: In-person visit

Atrial fibrillation

Atrial fibrillation, or AFib or AF, is a rapid, quivering, abnormal heartbeat. It occurs when electrical signals in the two upper chambers of the heart do not coordinate with signals in the two lower chambers.

Heart damage from high blood pressure, congenital heart defects, viral infections, and sleep apnea can cause atrial fibrillation. Other risk factors include increasing age, obesity, family history, and drinking alcohol.

The patient may notice a jerky, fluttering heartbeat; shortness of breath; and weakness. Chest pain is a medical emergency. Take the patient to the emergency room or call 9-1-1.

Untreated atrial fibrillation may lead to heart failure. Blood clots can form in the stalled circulation within the quivering heart, travel to other parts of the body, and cut off the blood flow to other organs.

Diagnosis is made through electrocardiogram, echocardiogram, blood test, stress test, and chest x-ray.

Treatment involves cardioversion with mild electrical shock or medication to return the heart to normal rhythm. Surgery may be done. Blood thinners and medication to maintain heart rhythm will be prescribed.

Aortic valve regurgitation

The aorta is the large blood vessel which leads directly out of the heart. If the heart's aortic valve – which controls the flow of blood out of the heart and into the aorta – does not close tightly between heartbeats, some of the blood flows backward into the heart instead of out into the aorta.

This condition may be present at birth or develop through calcium deposits that build up as a person ages. Other causes are illnesses such as endocarditis, rheumatic fever, or lupus.

Symptoms may take years to develop and include fatigue and lightheadedness; chest pain and shortness of breath during exercise; swollen feet and ankles; and irregular, fluttering heartbeat.

Aortic valve regurgitation can lead to heart failure, which is life-threatening. If the above symptoms are present, the person should see a medical provider as soon as possible.

Diagnosis is made through patient history, physical examination, chest x-ray, stress tests, echocardiogram, and electrocardiogram.

Treatment involves lifestyle changes; some medications; and sometimes surgery to repair or replace the aortic valve.

Narrowing of the aortic valve

Narrowing of the aortic valve is also called aortic valve stenosis, aortic stenosis, or AS. The aortic valve controls the flow of blood from the heart into the aorta, the body's main artery. If the aortic valve is abnormally narrow, the blood being pushed through it is blocked. Pressure may build up within the heart, causing damage.

AS may be caused by a congenital malformation of the valve, or by calcium deposits and/or the scarring that occurs as a person ages.

Symptoms may not appear right away. There will be chest pain with the feeling of pounding heartbeat, as well as shortness of breath with fatigue, lightheadedness, or even fainting.

It is important to see a medical provider for these symptoms, since AS can lead to stroke, blood clots, and heart failure.

Diagnosis is made through physical examination, echocardiogram, CT scan, and sometimes a stress test.

Treatment may simply involve monitoring and medication, while making lifestyle improvements in diet, exercise, weight, and smoking. Surgery to repair or replace the faulty aortic valve may be recommended.

Rarity: Uncommon

Top Symptoms: fatigue, shortness of breath, chest pain, shortness of breath on exertion, decreased exercise tolerance

Urgency: Hospital emergency room

Shortness of breath quiz

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Shortness of breath treatments and relief

Shortness of breath is a serious problem, especially if it worsens or persists. You should not delay consulting a physician; however, in the meantime, try to relax and catch your breath and remove yourself from any stressful situation, if possible.

When to see a doctor

During your initial evaluation, a doctor will likely focus on narrowing the potential shortness of breath causes with several tests, including:

  • Comprehensive physical exam: A close look at your breathing and other symptoms (such as cough) may help determine a diagnosis.
  • Imaging: A chest X-ray can reveal crucial information, while CT scans offer an even more detailed picture. Sometimes an ultrasound can be used as well.
  • Laboratory tests: Blood work can provide clues about a possible infection, inflammation, autoimmune diseases, and other causes of shortness of breath symptoms.
  • Pulmonary function tests: These tests will measure your breathing ability during various maneuvers.
  • Bronchoscopy: A pulmonologist can look into your airway and lungs with a small camera and may take biopsies for examination under a microscope.

Medical treatments

Once the underlying shortness of breath cause is determined, treatment can include:

  • Inhalers: These devices deliver aerosolized medication directly into the airway. They can provide immediate relief, such as during an asthma attack, or may have long-term benefits.
  • Other prescription medications: A doctor may prescribe a drug to treat your shortness of breath symptoms, slow the progression of your disease, or treat the underlying cause.
  • Oxygen: Supplemental oxygen can ease breathing and improve the quality of life for people with chronically low blood oxygen levels.
  • Surgery: A procedure in the hospital can drain fluid on the lung, repair trauma, or remove a mass, among many other possibilities.

At-home treatments

You can also help address the problem at home.

  • Take medications as prescribed: Medication compliance is very important to avoid unwanted side effects.
  • Avoid irritants: Some people find that very cold air triggers their shortness of breath symptoms while others point to cigarette smoke or pollen.
  • Smoking cessation: Smoking is a leading cause of preventable shortness of breath and even death. Your doctor can help develop strategies to help you quit.

When it is an emergency

Since breathing trouble can sometimes be a medical emergency, it's important to see help immediately if:

  • You feel like you cannot adequately control your symptoms at home
  • Your shortness of breath is worsening quickly: Or comes on all of the sudden
  • You also have chest pain
  • You feel weak, dizzy, or confused

FAQs about shortness of breath

What causes shortness of breath?

Shortness of breath is most commonly caused by exercise or exertion and a need to breathe off the lactic acid that builds up in bodily tissues during exercise. It can also be caused by diseases of the heart or lungs that make it more challenging to deliver oxygen or transfer oxygen into the blood or carbon dioxide out of the blood.

What is shortness of breath a symptom of?

Shortness of breath can be a symptom of normal bodily functioning during exercise, lung disease, cardiovascular disease, kidney disease, and liver disease. Essentially, it is caused by an inability of the body to deliver adequate oxygen to the blood while breathing at a normal and restful rate. The body compensates for some problem in oxygen delivery to match oxygen needs/consumption by increasing the breathing rate, which causes shortness of breath.

What causes shortness of breath and chest pain?

Shortness of breath and chest pain can be caused by an upper respiratory tract infection and severe coughing, a lower respiratory tract infection like pneumonia or bronchitis, and inflammation of the lining of the lungs, or cardiovascular disease like myocardial infarction. It can also be caused by a panic attack accompanied by hyperventilation or breathing too quickly due to fear.

Questions your doctor may ask about shortness of breath

  • Have you been feeling more tired than usual, lethargic or fatigued despite sleeping a normal amount?
  • Any fever today or during the last week?
  • Do you have a cough?
  • Do you notice your heart beating hard, rapidly, or irregularly (also called palpitations)?

Self-diagnose with our free Buoy Assistant if you answer yes on any of these questions.

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Dr. Rothschild has been a faculty member at Brigham and Women’s Hospital where he is an Associate Professor of Medicine at Harvard Medical School. He currently practices as a hospitalist at Newton Wellesley Hospital. In 1978, Dr. Rothschild received his MD at the Medical College of Wisconsin and trained in internal medicine followed by a fellowship in critical care medicine. He also received an MP...
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