Shortness of Breath ( Dyspnea ) and Early Fatigue

Before we move on to what shortness of breath is, how it relates to the heart, and other causes, ask, “What really is breathing?” Let’s answer the question.

Oxygen is a vital molecule found in the air and required for all our vital activities. It is indispensable for the body’s energy metabolism, it is indispensable. For example, while our brain can withstand only 3-5 minutes without oxygen, heart muscles suffer irreversible damage (infarction) within hours when they are without oxygen.

Here breathing is actually taking oxygen from the air. This work is accomplished by the harmonious operation of a rather complex chain of mechanisms in which the brain, nerves, hormones, diaphragm muscle, respiratory muscles in the chest wall, upper and lower respiratory tract, lungs and lung membranes play a role. After the oxygen is taken into the lungs, it enters the blood vessels by passing through very thin permeable membranes and is delivered to the heart by means of red blood cells (red blood cells), and from there to the whole body. This part of the event is called “circulation”, but if we look at it from the perspective of oxygen’s journey; Respiration and circulation are two interdependent and continuation mechanisms.

Disruptions at any point of respiration and circulation can occur as disorders, diseases, shortness of breath and early fatigue.

(Although “shortness of breath” and “early fatigue-fatigue” are often seen together, they are separate conditions in terms of cause, effect and approach. Since this distinction is mostly an academic issue, I prefer not to mention it here.)

After these preliminary explanations, “What is Shortness of Breath?” Let’s move on to the question.

Breathing is a spontaneous event that is rhythmically adjusted by our respiratory center in our brain, which we do not notice much unless our attention is directed. Shortness of breath (dyspnea) is the state of breathing that requires special effort, is difficult enough to be aware of, is tiring and can be performed with difficulty. If we look at it causally, we can also describe it as “oxygen starvation”.

Heart Caused Shortness of Breath:

The main mechanism in heart-induced dyspnea, to put it very simply, is the accumulation or backward flow (=stasis) of blood that the heart cannot pump and send forward for any reason. For easier understanding, blood has a journey like this, which you can examine in the following way:


It may have been a bit complicated though. Let’s simplify it even more.


If this flow encounters an obstacle at any point or events that reverse the flow, it results in an increase in pressure and volume that starts in the area just behind the point of the obstruction and progresses towards the more posterior areas over time.

Let’s think like this:  Let there be a village built by the river, a dam downstream, a dam that always allows a certain amount of water to pass through. Under normal circumstances, there is no problem in the village by the river. However, if the dam gates remain closed all the time and do not allow water to pass through, the water level starts to rise in the areas behind the dam and if this continues for a long time, the village behind will be flooded.

Let’s imagine this village as our lungs and the dam as our heart. If, for some reason, the dam cannot send the water as it should, the village will be flooded, and if our heart cannot send the blood forward in any way, our lungs behind will flood, that is, pulmonary edema occurs. This causes shortness of breath as it reduces the lung’s capacity to fill with air and mix oxygen into the blood.

In situations that accelerate the heart (ie, if we compare it again, if there is the same dam cover problem in a river that is overflowing with the melting of snow in spring, the village will be flooded more easily), shortness of breath becomes more pronounced.

Common causes of heart-related shortness of breath are:

Heart Failure : The loss of the pumping power of the heart muscle for any reason is called “Heart Failure”. Since the heart cannot send blood forward (to the body), the blood flowing backwards to the lungs causes shortness of breath. While the loss of strength in the heart muscle may be due to many reasons, it most often occurs as a result of insufficient nutrition of the heart in coronary vascular diseases and the enlargement of the heart and loss of elasticity due to valve diseases.

Valve Diseases:If the valves that need to be opened in front of the rapidly flowing blood in the heart do not open (most commonly Mitral Valve Stenosis and Aortic Valve Stenosis) or if the valves that need to be closed to prevent the blood from flowing in the opposite direction (most commonly Mitral Valve Insufficiency and Aortic Valve Insufficiency), the blood will still cause pressure and pressure in the lungs. It causes shortness of breath by causing an increase in volume.

Cardiac Diseases:In case of excessive fluid accumulation (tamponade) or adhesions between the membranes, heart failure and therefore shortness of breath develops as the heart cannot expand enough and take enough blood into it.

Coronary Vessels Diseases: Angina pectoris, which is caused by the narrowing and occlusion of the heart vessels, can sometimes be perceived as shortness of breath. This type of shortness of breath is called the “angina equivalent.” In addition, pumping failure due to the inability of the heart muscle to be fed is also a cause of shortness of breath.

Cardiac arrhythmias and cardiomyopathies are also other causes of heart-related shortness of breath.

Depending on the level of the disease, heart-induced dyspnea can occur only with advanced exercise, or even at rest in advanced disease. Sudden onset of advanced shortness of breath, severe dry-itchy cough and subsequent pink foamy sputum indicates that almost all of the lungs are filled with fluid, which is called “Lung Edema”. The phrase that best describes pulmonary edema is; It is “man drowning in his own water”.

Shortness of breath that develops while lying down is mostly related to the heart. It also has a cough. Shortness of breath, which develops 2-3 hours after going to bed at night, usually improves by getting up and sitting down. Attacks can be mild, as well as wheezing, coughing, severe shortness of breath and accompanying panic. Sometimes it can go up to pulmonary edema. In people with heart failure, it develops due to the increase in central blood volume at night. When the pooled blood in the legs is added to the central blood system at night, the heart, which is already working at the border, goes into insufficiency.

Other Causes of Shortness of Breath:

Lung Diseases: The most common causes of shortness of breath, along with heart diseases. In many cases, it can be difficult to distinguish which is the cause of shortness of breath. Sometimes both are the cause. Lung infections (pneumonia), chronic bronchitis, asthma, pulmonary embolism, pneumothorax, lung cancers, pleura inflammation, sarcoidosis, pulmonary hypertension and tuberculosis may be related causes of shortness of breath.

Blood diseases (often anemia), overweight (obesity), thyroid hormone disorders, upper respiratory tract occlusive diseases, some neurological diseases (myasthenia, Gullian-Barre Syndrome), anxiety (stress) disorders are among the causes of shortness of breath.

We can say that a situation that is common and thought to be a disease is “physical lack of exercise”. The inactive muscles of the 21st century man, who lives sitting still, parks his car at the closest point to his work and home, and waits for the escalator in the subway-shopping center, lose their strength, and when he walks two steps, he gets tired early and gets short of breath. The remedy is to walk….

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