Ever since she had turned 50, my college chum Jackie had felt increasingly short of breath when trying to do her normal workout or climb a few flights of stairs. Her blood pressure reading and blood work seemed fine, so when her doctor said, “Welcome to middle age,” Jackie shrugged off the breathing problem. But alarms went off in her head when she read the article “Shortness of Breath Is Not a Symptom of Aging” in a recent issue of Bottom Line/Personal (a sister publication of HealthyWoman). Armed with the article, which warned of asthma, Jackie insisted that her doctor refer her to a specialist.
My friend didn’t have asthma, it turned out. She had something much worse—pulmonary hypertension, a type of high blood pressure that affects the arteries that carry blood from the heart to the lungs. She is going to be OK now that she’s getting the treatment she needs… but if Jackie’s diagnosis had been delayed much longer, she might have lost her life.
It’s easy to understand why Jackie dismissed her symptoms at first, because we all feel breathless at times—if we’re exercising hard, fighting a cold or are a bit out of shape. The hard part is knowing when dyspnea (the medical term for shortness of breath) might signal a potentially serious problem. I contacted pulmonary disease specialist Zeenat Safdar, MD, associate director of the Pulmonary Hypertension Service at Baylor College of Medicine in Houston, to discuss what women should know about pulmonary hypertension and other causes for shortness of breath.
Pulmonary hypertension develops when tiny arteries in the lungs become narrowed, stiffened or blocked due to cellular changes or scarring in the arteries’ lining, Dr. Safdar explained. As blood flow is constricted, pressure in the pulmonary arteries rises and blood backs up, forcing the heart to pump harder. (Because blood flow between the heart and lungs is a separate “loop” in the circulatory system, pulmonary hypertension does not show up on arm cuff blood pressure readings.)
At first, symptoms occur only during exertion—and often are wrongly attributed asthma, anxiety or being out of shape—but eventually dyspnea becomes constant. Additional symptoms include palpitations or racing heartbeat… dizziness or light-headedness… fatigue upon exertion… swollen ankles, legs or belly… and bluish lips and skin.
The longer pulmonary hypertension goes undiagnosed and untreated, the more damage is done. Possible consequences include arrhythmias, heart failure, bleeding into the lungs and sudden cardiac death. The good news: For most patients, pulmonary hypertension can be controlled with lifestyle changes and medication.
Not all cases of dyspnea are due to pulmonary hypertension, of course—in fact, there are dozens and dozens of different medical conditions that can cause shortness of breath. These include…
Kidney disease. When kidneys don’t work properly, two complications contribute to dyspnea—anemia (a shortage of oxygen-carrying red blood cells) and buildup of fluid in the lungs.
Pulmonary embolism (blood clot in the lungs). Sudden, unexplained shortness of breath accompanied by sharp chest pain and/or coughing signal this life-threatening medical emergency.
Cardiac problems. Possible heart-related causes of dyspnea include cardiomyopathy (weakened and/or enlarged heart muscle)… arrhythmia (irregular heartbeat)… pericarditis (inflammation of the sac around the heart)… or heart failure (in which the heart cannot pump enough blood to meet all of the body’s needs). As Dr. Safdar pointed out, many people do not realize that shortness of breath also can be a symptom of heart attack. Noteworthy: A study in The New England Journal of Medicine found that, among patients with no known history of coronary artery disease, those with dyspnea had four times the risk of sudden death as patients without dyspnea.
To protect yourself (as my friend Jackie learned), you need to take any and all breathing difficulties seriously. Here’s what to do if you…
