Shortness of Breath Causes and Examples: Just “BREATHE”
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SAVE TIME studying and click below for your own copy of the lecture below! QUICKLY learn the main causes of shortness of breath! Simple explanations of diseases and a MUST-HAVE mnemonic included!
Shortness of Breath Causes
There are many conditions that can cause shortness of breath (dyspnea), and it can be challenging to remember them all….right?
Wrong!
Fortunately, you just landed on a goldmine.
EZmed came up with an original, clever mnemonic to help you remember the major urgent/emergent conditions that can lead to shortness of breath.
The mnemonic is “BREATHE”…..which is very fitting!
With so many variables to shortness of breath, this mnemonic will help ensure you don’t miss or forget an emergent condition.
For example, shortness of breath symptoms may be associated with fatigue, chest pain, chest tightness, anxiety, dizziness, cough, or congestion.
Moreover, shortness of breath may be present during pregnancy, with exertion or activity such as running or walking, when lying down, after eating, or at night.
Example conditions associated with shortness of breath include pneumonia, viral infections such as COVID, asthma, COPD, myocardial infarction (heart attack), congestive heart failure, pneumothorax (collapsed lung), anaphylaxis, arrhythmias such as atrial fibrillation, and many more!
Some conditions are emergent while others are less urgent.
And the mnemonic can help you remember the emergent ones!
So let’s get right into it!
Shortness of Breath Mnemonic
The mnemonic to remember the main emergent causes of shortness of breath is “BREATHE”.
The mnemonic primarily focuses on urgent intrathoracic conditions that can lead to dyspnea.
It is important to note that other causes not listed can also become emergent, and there are certainly conditions outside the thorax that can lead to dyspnea as well.
However, this mnemonic is useful to help you remember the main pulmonary and cardiac causes.
To see how this mnemonic can be applied clinically to manage shortness of breath, check out the “Approach to Shortness of Breath: The BREATHE Mnemonic”
Now the moment we’ve been waiting for…..enjoy the mnemonic and examples below!
“BREATHE”
Bacterial (Pneumonia, Bacterial Endocarditis)
Reactive Airway Disease (Asthma, COPD)
Embolism (Pulmonary Embolism)
Acute Coronary Syndrome/Airway Obstruction
Tension Pneumothorax/Tamponade
Heart Failure
Electrical Excitement (Arrhythmia)/Edema/Effusion
Image: Use the “BREATHE” mnemonic to remember the main urgent/emergent causes of shortness of breath.
Shortness of Breath Causes
Let’s now walk through the “BREATHE” mnemonic and discuss examples below.
B = Bacterial
The “B” in the mnemonic stands for bacterial, and it will help you think of bacterial causes.
This includes bacterial infections such as pneumonia.
It will also help you remember bacterial endocarditis, which is often forgotten or overlooked in the initial differential diagnosis.
Bacterial endocarditis is an infection involving the heart, usually caused by bacteria in the bloodstream called bacteremia.
Individuals who use IV drugs are prone to endocarditis, therefore it is important to take a full history in every patient including a social history.
If the infective endocarditis involves the right side of the heart (tricuspid valve), then the infection can spread from the right heart to the lungs, a condition known as septic pulmonary emboli.
Septic pulmonary emboli can worsen the shortness of breath.
R = Reactive Airway Disease
The “R” in the mnemonic stands for reactive airway disease.
While reactive airway disease is a general term, it is helpful for the purpose of this mnemonic.
You can use reactive airway disease to help you remember obstructive pulmonary diseases as a potential cause of shortness of breath.
Obstructive lung diseases typically involve conditions that lead to bronchoconstriction, bronchospasm, difficulty exhaling, and wheezing.
Conditions may include asthma, COPD (emphysema or chronic bronchitis), bronchiolitis, and anaphylaxis to name a few.
You may also use the “R” in the mnemonic to help you remember “Restrictive lung disease”.
Unlike obstructive lung disease in which exhaling all of the air out is difficult, restrictive lung disease usually leads to difficulty inhaling or expanding the lungs.
Conditions that result in restrictive lung disease include pulmonary fibrosis/interstitial lung disease, sarcoidosis, obesity, and neuromuscular diseases to name a few.
E = Embolism
The “E” in the mnemonic will help you think of embolism, specifically a pulmonary embolism.
A pulmonary embolism (PE) is an obstruction of the pulmonary arteries.
A PE may lead to shortness of breath and pleuritic chest pain.
If severe enough, a PE can also lead to cardiopulmonary dysfunction and inadequate perfusion of oxygenated blood to tissues and organs - a type of obstructive shock.
Pulmonary emboli are typically the result of blood clots that travel from a part of the body to the lungs.
Commonly the blood clot originates in the deep veins of the leg, known as deep vein thrombosis (DVT), which can then travel to the lungs.
Risk factors for DVT/PE include long periods of immobilization (recent surgery, recent hospitalization, paralysis, long bed rest, long traveling, etc), pregnancy, oral contraceptive therapy, hormonal replacement therapy, cancer, age, obesity, and coagulation disorders to name a few.
A = Acute Coronary Syndrome/Airway Obstruction
The “A” will help you remember a couple different causes:
Acute coronary syndrome
Airway obstruction
1. Acute Coronary Syndrome
First, acute coronary syndrome (ACS) includes the conditions in which there is decreased blood flow to the heart such as a myocardial infarction (heart attack).
ACS typically refers to a spectrum of clinical presentations including ST elevation myocardial infarctions (STEMIs), non-ST-elevation myocardial infarctions (NSTEMIs), and unstable angina.
Nonetheless, this part of the mnemonic is to help you remember that cardiac conditions (in addition to pulmonary) can cause shortness of breath as well.
Cardiac conditions that may cause shortness of breath include pericarditis, myocarditis, heart failure (discussed later), and cardiac tamponade/pericardial effusion (discussed later) to name a few.
2. Airway Obstruction
The “A” can also help you remember airway obstruction.
This will encompass any condition that can causes obstruction of the airway including foreign body, aspiration, angioedema, and anaphylaxis to name a few.
If “airway obstruction” is too broad of a category for you, then you can also use the “A” in aspiration, angioedema, and anaphylaxis to help you remember airway obstruction as a potential cause of shortness of breath.
T = Tension Pneumothorax/Tamponade
The “T” can be used to help you remember a couple different conditions:
Tension pneumothorax
Tamponade
1. Tension Pneumothorax
First, a pneumothorax (collapsed lung) is an abnormal collection of air in the pleural space/cavity between the lungs (visceral pleura) and chest wall (parietal pleura).
A tension pneumothorax occurs when there is a one-way valve that allows air to enter the pleural space but not exit.
This can lead to increased intrathoracic pressure and near collapse of the lung.
As the volume of air increases within the pleural space, it can exert pressure on the heart and vasculature.
The increased intrathoracic pressure can lead to compromise of venous return, which can negatively impact stroke volume, cardiac output, and blood pressure.
This can lead to a type of shock known as obstructive shock.
A tension pneumothorax can also cause tracheal or mediastinal deviation away from the affected side.
While a tension pneumothorax is not the only type of pneumothorax, the term can be used as the “T” in the mnemonic to help you remember pneumothoraces in general.
2. Tamponade
The “T” can also be used for tamponade.
This will help you think of cardiac tamponade and pericardial effusion.
A pericardial effusion is the accumulation of fluid in the pericardial space between the heart and fibrous pericardium (the sac surrounding the heart).
Cardiac tamponade physiology may occur when the fluid in the pericardial space accumulates to the point where it compresses the heart and disrupts cardiac function.
The chambers of the heart (particularly the ventricles) are in a low pressure state during diastole, and the pressure outside the heart is higher than usual during cardiac tamponade.
As a result, cardiac tamponade can collapse the ventricles during diastole (diastolic collapse) and negatively affect the heart’s ability to fill with blood.
Cardiac tamponade may be deleterious to the contraction of the heart during systole as well.
As a result, cardiac tamponade may cause decreased stroke volume, cardiac output, and inadequate perfusion of oxygenated blood - Another form of obstructive shock.
H = Heart Failure
The “H” in the mnemonic stands for heart failure.
Heart failure is a condition in which the heart is unable to pump enough blood to meet the needs of the body.
A number of conditions can cause heart failure including chronic hypertension (high blood pressure), valvular disease, coronary artery disease, previous myocardial infarction, and arrhythmias to name a few.
E = Electrical Excitation, Edema, Effusion
The “E” in the mnemonic can be used to remember several different causes of shortness of breath including:
Electrical Excitation (Arrhythmias)
Edema (Pulmonary)
Effusion (Pleural)
1. Electrical Excitation (Arrhythmias)
Electrical excitation will help you think of arrhythmias.
For the purpose of this mnemonic, this may include an abnormal heart rate and/or rhythm such as atrial fibrillation, bradycardia, supraventricular tachycardia, or ventricular tachycardia to name a few.
2. Edema (Pulmonary)
The “E” can also be used to remember edema, specifically pulmonary edema which is excess fluid in the lungs.
Pulmonary edema is often caused by congestive heart failure, however there are other causes as well which will be discussed in a different EZmed lecture.
3. Effusion (Pleural)
Lastly, you can use the “E” to remember effusion, specifically a pleural effusion which is fluid around the lungs in the pleural space.
Pleural effusions can be caused by a number of conditions including congestive heart failure, cirrhosis, neoplasm, infection, and hemothorax to name a few.
Summary
Hopefully the mnemonic “BREATHE” gave you a simple way to remember the main causes of shortness of breath, particularly the urgent/emergent conditions.
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