Breathlessness

As a clinician this is the most challenging symptom to treat and requires commitment on your part to reduce the symptom of breathlessness.  The reason for this is that the three system are usually involved and each will require some intervention.

The three systems:

• Ventilatory system – incorporating the lung tissue, the structure if the chest and your mechanics of breathing including how your diaphragm functions
• Circulatory system – this includes your heart and the artery and veins in your system
• Musculature

Breathlessness is a common symptom of heart disease. Anyone who has experienced it knows that can be an uncomfortable and frustrating sensation. Being short of breath uses a large amount of energy so after a bout of breathlessness, you may feel very tired. It is important to learn about breathlessness, so that you can detect any change in your symptoms and manage it appropriately.

Reasons your heart disease may be causing your shortness of breath:

• After a cardiac event or surgery: Sometimes, after a cardiac event e.g heart attack or surgery, you may experience what is called diaphragmatic dysfunction. You may feel more breathless than you normally would doing a certain activity. You may also feel quite tired or find yourself yawning a lot. Luckily, a device called an inspiratory muscle trainer can help to retrain your diaphragm to take in more oxygen. If you are concerned about diaphragmatic dysfunction, talk to a member of the team at Heart 2 Heart.

• Heart failure: Heart failure occurs when your heart is having trouble pumping enough blood around your body. This can cause blood to back up in the vessels traveling from the lungs to the heart. If this happens, fluid can leak into the lungs and gather there, causing you to become short of breath.

If you have heart failure, you may also feel more breathless lying down. As you lie down, the fluid spreads across the surface of the lungs – imagine water in a bottle when it is upright and how it spreads out when you lie it on its side.

• Heart arrhythmia: If there are any problems with your heart rhythm, this can cause symptoms of breathlessness. Examples of heart arrhythmias are as atrial fibrillation (an irregular and fast heart rate) or supraventricular tachycardia (regular and fast heart rate).

Along with the heart, there may be other underlying causes for your breathlessness:

Lung conditions and Breathlessness 

Lung conditions can cause breathlessness for several reasons. Some cause the airways to become narrowed and inflamed, which makes it harder for air to move in and out of the lungs. Other conditions make the lungs become stiff and less elastic, so it is harder for the lungs to fill with air.

Some of these conditions include Chronic Obstructive Pulmonary Disease (COPD), bronchiectasis, and lung cancer. A blood clot in the lung can also occur which can cause breathlessness.

Anxiety and Breathlessness

Some people feel shortness of breath when they are anxious, as your body starts to breathe faster and tense the muscles of breathing

Low exercise capacity

When we are unfit, our muscles are weaker. This includes our breathing muscles. Weaker muscles need more oxygen to work properly, so the weaker our muscles, the more breathless we feel.

Obesity and Breathlessness 

If you are overweight, it takes more effort to breathe and move around. Having more weight around the chest and stomach area restricts the movement of your lungs.

Management of Breathlessness

1. Try asking yourself some of the following questions if you are feeling breathless:

• Did it come on suddenly or gradually?
• Did anything trigger it e.g exercise?
• How bad is it? Does it only ever happen when you have been active e.g out walking, or does it come on when you are not doing anything?
• Is there any pain when you breathe?
• Do you have a cough?
• Do certain positions make it worse – e.g, are you able to lie down?

2. Try to listen to your body. If you only become breathless when exercising, then learn to recognise when it starts, and stop the next time when it begins. It is important to find a level of activity that you can maintain.

If you are breathless and the doctor has established that you are stable, it is important that you start an exercise regime starting with a gentle walk of 5 minutes and gradually adding in 5 minutes per week. Each time you increase the walk by 5 minutes, you will need to check how you are feeling.  If you feel extremely tired after it, this means that you have done too much, and you need to reduce the increase to one minute.

3. If you become breathless when resting, you should talk to your doctor or healthcare team about how best to manage this. They may need to adjust your treatment or some of your medications. If you feel breathless when lying down, try supporting yourself with several pillows so that you are lying in a more upright position.
4. Try positioning yourself in one of the following positions when you feel breathless:

5. Inspiratory Muscle Training:

We also may start you on an inspiratory muscle training (IMT) regime. IMT is a form of weight training which strengthens the diaphragm, which is the main muscle used for breathing. When the diaphragm is strengthened regularly for a period of a few weeks, it adapts, becomes stronger and is able to work for longer. You will also be able to exercise for longer without becoming as breathless.

By improving your inspiratory strength, you will increase the amount of oxygen that can be inhaled into your lungs, which will result in a decrease in energy consumption. This will enhance your endurance – endurance is the ability to last longer during physical activity.

At Heart 2 Heart we run programmes that help with the management of breathlessness and improve exercise capacity.  Before you start on a programme, we will complete an exercise test with you.

We perform this exercise test with you for two reasons:

• To start your exercise regime at the right level
• To see if there are any causes for the breathlessness that a physiotherapist can manage with exercise training

 It is important to remember that shortness of breath is also a common symptom of COVID-19. If you notice any deterioration in your shortness of breath, please contact your GP.

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