Shortness of Breath

Shortness of breath is a common symptom. An evaluation of shortness of breath includes an assessment of the lungs, heart, and blood.

During breathing, the lungs take in oxygen which is transferred to blood.  The oxygen is needed by the working cells throughout the body.   Lung disease compromises oxygen intake, and transfer to body tissue.  It is broadly categorized as either obstructive or restrictive (although both can exist at the same time).  The most common obstructive lung disease is COPD (Chronic Obstructive Pulmonary Disease), or emphysema.

Restrictive lung disease is a limitation of lung expansion. It is analogous to a balloon which is only capable of being blown up to ½ of its potential size.  This limitation of expansion lessens the effectiveness of oxygen intake.

An assessment of lung health is done through pulmonary function testing (generally done in the doctor’s office), as well as through imagery such as chest x-ray and ct scan. The physician with expertise in lung function is known as a pulmonologist.

Heart dysfunction may also contribute to shortness of breath. The heart has four (4) chambers (compartments), and 4 valves (like doors). The heart has a right side, and a left side. The right side receives blood that has delivered oxygen to body tissue.  The blood that enters the right heart is pumped to the lungs to pick up oxygen.  The blood then returns into the left side of the heart.  The left heart pumps blood throughout the body.

Shortness of breath related to heart disease may be a consequence of the inability of the heart to effectively circulate blood to the lungs to get oxygen, or to circulate blood to body tissue.  Cues to heart disease in patients with shortness of breath include heart rate and blood pressure.

Heart health is evaluated by various types of stress tests, and by echocardiograms which allow direct visualization of the heart through ultrasonic waves.  The physician with expertise in heart function is known as a cardiologist.

The third element of the evaluation of the patient who is short of breath is blood. Oxygen is carried by hemoglobin. Anemia is a condition in which the blood does not have enough hemoglobin to carry the needed oxygen to body tissues. Although anemia can be caused by many different conditions, it is generally the result of loss of blood and/or a lack of the production of blood.

Females are more likely to be anemic due to the menstrual period.  The evaluation of the anemic patient often involves investigation of the female reproductive tract, and the intestinal tract.  These are areas of potential occult, or overt blood loss.

If the source of blood loss can’t be found in the anemic patient, the patient will often be referred to a blood specialist. The physician who is a specialist in blood disorders is known as a hematologist.

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