Dyspnoea or breathlessness is one of the major warning signs of heart disease. It is one of the earliest and most frequent complaints among patients with cardiac disorders. Not necessarily, heart diseases manifest with chest discomfort and heaviness.
Breathlessness may indicate serious conditions like
- Coronary artery disease (blocks in coronary circulation reduces oxygen supply and cause exertional breathlessness)
- Heart failure ( heart cannot pump blood efficiently leading to fluid build-up in the lungs )
- Valve disorders (stenosis or regurgitation can cause increase in lung pressures )
- Arrhythmias (Irregular heartbeats can reduce cardiac output causing fatigue and dyspnoea)
- Cardiomyopathy( heart muscle cannot pump effectively).
Not everyone with heart disease experiences chest pain, but in many patients dyspnoea can act as an angina equivalent that is, the patient might feel breathlessness on exertion which may be due to reduced blood supply to the heart muscle. This often delays diagnosis, as patients may think its just due to aging or due to lack of physical activity.
Dyspnoea or breathlessness can be due to cardiac or pulmonary causes or mixed. Differentiating between cardiac and pulmonary causes of breathlessness (dyspnea) is essential because the treatment and urgency can differ greatly. While symptoms often overlap, there are key differences in the onset, associated features, physical findings, and diagnostic tests that can help distinguish them.
Breathlessness due to cardiac causes is often sudden or related to exertion or lying flat. Pulmonary causes usually be gradual as in chronic lung diseases, but can occur sudden as in asthma attack. Cardiac dyspnoea is usually positional; orthopnoea – breathlessness while lying down or paroxysmal nocturnal dyspnoea. Cough associated with cardiac dyspnoea may produce pink frothy sputum as in pulmonary oedema. On the other hand, cough due to pulmonary causes produce productive sputum.
Cardiac dyspnoea may be associated with anginal episodes, leg swelling or oedema (especially in heart failure), palpitations and fatigue. On the other hand, dyspnoea due to pulmonary causes may be associated with pleuritic chest pain and wheeze; palpitations and oedema uncommon, except in cor-pulmonale (secondary heart dysfunction in long standing COPD)
Those presenting with breathlessness due to heart related causes may have history of long standing hypertension, coronary artery disease or valvular heart diseases. History of asthma, allergies in the past, smoking, recent lung infections, history of COPD – all point towards pulmonary causes of dyspnoea.
Diagnostic Tests to Help Differentiate between Cardiac and Pulmonary causes of dyspnoea.
- Chest X-ray
- Cardiac: Enlarged heart, pulmonary vascular congestion.
- Pulmonary: Hyperinflated lungs (COPD), infiltrates (pneumonia), pneumothorax, etc.
- BNP or NT-proBNP
- Elevated in heart failure.
- Normal in most pulmonary causes.
- ECG
- Cardiac: Ischemia, arrhythmias, hypertrophy.
- Pulmonary: May show signs of PE (S1Q3T3), cor pulmonale (RV strain).
- Echocardiogram
- Assesses ejection fraction, valve function, wall motion (confirms cardiac causes).
- Pulmonary Function Tests (PFTs)
- Abnormal in asthma, COPD, ILD; usually normal in cardiac causes.
- D-dimer / CT Pulmonary Angiogram
- Helps rule in/out pulmonary embolism.
Urgent evaluation is needed if the onset of dyspnoea is sudden or if it is present at rest, associated with chest pain or palpitations, accompanied by swelling in the lower limbs.
Treatment of heart-related breathlessness (dyspnea) focuses on addressing the underlying cardiac condition, relieving fluid overload, improving oxygenation, and reducing the work of breathing.
Stepwise Approach for patients presenting with cardiac dyspnea
- Stabilize the patient with propped up position, oxygen and vitals monitoring
- Reduce preload and congestion (diuretics, nitrates)
- Treat the underlying cause (ischaemia, arrhythmia, valvular problems, etc)
- Long term management – Heart failure drugs, lifestyle changes and periodic follow-ups
- Consider surgical/device therapy in advanced cases
Conclusion
Dyspnoea is more than just a symptom—it can be an important early warning sign of heart disease. Recognizing breathlessness as a possible angina equivalent and understanding whether its origin is cardiac or non-cardiac are vital steps toward timely diagnosis and treatment.
Early medical attention not only prevents complications but also improves long-term heart health and quality of life.If you or a loved one experience unexplained or persistent shortness of breath, it’s essential to consult experts without delay.
Seeking care from the best cardiology hospital in Trivandrum ensures access to advanced diagnostic tools, experienced cardiologists, and personalized treatment plans—helping you breathe easier and live healthier.
