DOCTOR'S VIEW ARCHIVE
Medical Authors and Editors: Barbara K. Hecht, Ph.D. and Frederick Hecht, M.D.
November 15, 2004 -- Vice President Dick Cheney complained of shortness of breath and underwent tests at a Washington hospital this weekend. There was concern because the vice president has had significant heart problems for years but Mr. Cheney was able to go home from the hospital after three hours.
His cardiologist, Dr. Jonathan Reiner, issued a statement saying: "Tests ruled out any cardiac cause of the vice president's symptoms. Tests also ruled out pneumonia and other pulmonary causes. The vice president likely has a viral upper-respiratory infection."
Formal medical statements tend to be just that -- formal. To put Mr. Cheney's condition into everyday words, we might say: "He did not have a heart attack or pneumonia. He probably just has a bad cold."
Shortness of Breath
Shortness of breath, medically known as dyspnea, is an important symptom but there is no standard definition for it. However, the causes of shortness of breath or dyspnea fall into simple categories. These categories include anxiety, muscle and nerve diseases, heart disease, lung vessel diseases, lung disease, and obstruction to airflow.
Anxiety can lead to acute or chronic hyperventilation (excessively rapid breathing). An average 150 pound (70 kilogram) adult breaths at an average rate of 14 breaths per minute at rest. Excessively rapid breathing is referred to as hyperventilation. It is a common cause of shortness of breath.
Muscle & Nerve Diseases
Numerous diseases of muscles and the nervous system can lead to shortness of breath by weakening the body's capacity for opening the lungs up for respiration. Examples of muscle diseases include muscular dystrophy, polymyositis, and dermatomyositis. Examples of nervous system diseases that can cause shortness of breath include Lou Gehrig's disease (ALS) and multiple sclerosis.
Many conditions that affect the heart and its capacity to move blood through the lungs can lead to shortness of breath. These conditions include a heart attack (that Mr. Cheney feared), congestive heart failure, and heart valve disease.
Lung Vessel Disease
The blood vessels that transport blood to and from the lungs and permit the vital exchange of carbon dioxide for oxygen can be compromised by disease and lead to shortness of breath. Examples of conditions that affect these blood vessels include pulmonary embolism (a clot in the lungs), pulmonary hypertension (high blood pressure in the pulmonary artery), and pulmonary vasculitis (inflammation of pulmonary vessels).
Lung diseases that can cause shortness of breath include infections such as pneumonia and bronchitis, lung cancer and cancer that has spread to the lung, chemical and radiation toxicity to the lung (including radiation therapy), occupational toxicities (such as from silicon in mines), sarcoidosis, hemosiderosis, tuberculosis, fungus infections such histoplasmosis and coccidiomycosis (valley fever), allergic reactions (hypersensitivity pneumonitis) drug toxicity, and connective tissue diseases such as rheumatoid arthritis and lupus.
Obstruction To Airflow
Obstruction to airflow can occur in the nose or mouth, the trachea (windpipe in our throats), bronchial tubes, or the tiny airways in the lungs. The obstruction to airflow can be acute (sudden), intermittent, or chronic.
Sudden blockage of airways is a medical emergency and can be caused by inhaling objects, food particles or fluids. It can also be caused by swelling of the glottis (breathing flap) in the back of the throat from an allergic reaction.
Intermittent obstruction of the airflow can come from conditions that irritate or swell the bronchial airways, such as asthma, chronic bronchitis, or bronchiectasis.
Chronic shortness of breath is characteristic of emphysema and COPD (chronic obstructive pulmonary disease). The shortness of breath may be even at rest and be progressive.
Acidosis such as from aspirin poisoning, diabetes that is out of control, and kidney failure are among the many other causes of shortness of breath. So, of course is low oxygen as at high altitudes or running out of air while diving.
"The vice president likely has a viral upper-respiratory infection," said his cardiologist. A URI like a bad cold can also do the trick. It can make for trouble breathing, especially at night, as we all know.
Related MedicineNet Links
- Heart of Dick Cheney - Another Angioplasty (Doctor's View)
- Mr. Cheney's Chest Pain - And Heart Attack (Doctor's View)