Short of air? It could be your heart
Even if you have no chest pain, shortness of breath could be a warning sign, a study suggests.
Published November 3, 2005
NEW YORK - One simple question - Do you have trouble breathing? - may reveal as much about someone's risk of dying as the most relied-upon sign, chest pain.
Even people without any other cardiac symptoms were up to four times more likely to die of heart problems in the next few years if they had shortness of breath, a study of nearly 18,000 people suggests.
"Shortness of breath is not a sign to be ignored. It means make sure that your doctor knows about your symptoms," said Dr. Daniel S. Berman, senior author of the study, done at Cedars-Sinai Medical Center in Los Angeles.
Doctors take into account a number of risk factors and symptoms but especially chest pain when deciding whether someone might have heart disease and needs further tests. But it wasn't always clear how much weight they should give shortness of breath, he said.
Dr. Gerald Fletcher, a cardiologist at the Mayo Clinic in Jacksonville and a spokesman for the American Heart Association, said women might benefit more from closer attention to shortness of breath since they are less likely to suffer classic chest pain.
Researchers at Cedars-Sinai reviewed the medical records for 17,991 patients who had stress tests to see if troubled breathing was useful in predicting someone's outcome. They found the patients who reported being short of breath had a higher rate of death from heart trouble or any other cause.
"We don't know why some people get chest discomfort and others get shortness of breath. But in many patients we think the shortness of breath should be thought of as being an equivalent to having chest discomfort with exertion," Berman said.
It is the unexplained shortness of breath that might be a sign of heart disease, Berman said.
The study is reported in the New England Journal of Medicine.
In the Tampa Bay area, two local cardiologists said doctors already view shortness of breath as a key warning sign for heart disease.
"That can be just as ominous as typical (chest pain) symptoms," said Dr. Anne B. Curtis, chief of cardiology and director and CEO of cardiovascular services at the University of South Florida.
"You ask if they have chest pain and they say no, but you ask if they have shortness of breath ... and it turns out they have significant blockage in their coronary arteries," said Dr. Fadi Matar, a cardiologist at Florida Cardiovascular Institute who is on staff at Tampa General Hospital.
Shortness of breath can be a sign the heart isn't pumping strongly enough, so blood backs up into the lungs. Fluid builds up, causing shortness of breath, said Curtis, who also is president of the Heart Rhythm Society.
Or the heart can't pump enough blood to the lungs, so they can't oxygenate blood, and the person feels short of breath, Matar said.
Both doctors said shortness of breath doesn't always indicate heart disease. Anemia and obesity are among the other possible causes, Matar said.
"We're talking about shortness of breath for normal daily activities," Curtis said. "People can't go to the mall and walk around, or can't do housework. That's not normal and it should be checked out."
The study participants were sent to Cedars-Sinai for a sophisticated stress test over a 10-year period. They were asked if they had shortness of breath.
In the next one to five years, those with shortness of breath and no history of heart disease had four times the risk of death from heart problems than those with no symptoms.
Times staff writer Lisa Greene contributed to this report.AT A GLANCE: SYMPTOMS
The American Heart Association and other medical experts say the body likely will send one or more of these warning signals of a heart attack:
Chest discomfort with lightheadedness, fainting, sweating, nausea or shortness of breath.
Uncomfortable pressure, fullness, squeezing or pain in the center of the chest lasting more than a few minutes.
Pain spreading to the shoulders, neck or arms. The pain could be mild to intense and could feel like pressure, tightness, burning or heavy weight. It could be in the chest, upper abdomen, neck, jaw or inside the arms or shoulders.
Anxiety, nervousness and/or cold, sweaty skin.
Paleness or pallor.
Increased or irregular heart rate.
Feeling of impending doom.