What’s Up Doc?: Unexplained shortness of breath should be investigated
By DR. NOORALI BHARWANI on May 10, 2022.
Recently, a relative of mine died. She had shortness of breath. She went to the ER and was admitted to a hospital. She was investigated. After a week of investigations, she underwent coronary angioplasty for a narrow coronary artery. Two days later she was discharged. She went home and within an hour she fainted and died. That was sudden and tragic. Statistics show one in 20 patients with unexplained shortness of breath in the primary care setting will have heart failure as its cause. Statistics also show 38 per cent of patients with unexplained shortness of breath do not receive a definitive diagnosis within six months post-referral. When a person presents with shortness of breath, the clinician has to determine whether it is due to cardiac (heart failure) or pulmonary cause. Heart failure – also known as congestive heart failure - occurs when the heart muscle doesn’t pump blood as well as it should. When this happens, blood often backs up and fluid can build up in the lungs, causing shortness of breath. What causes heart failure? Common causes are coronary artery disease, heart valve disease, high blood pressure and cardiomyopathy. If you’ve been diagnosed with one of these conditions, it’s critical you manage it carefully to help prevent the onset of heart failure.  How would you know you are in heart failure? Swelling of the feet and ankles, shortness of breath, fatigue, abdominal fullness due to swelling and distention of the liver are early manifestation of heart failure. If you have these symptoms, you should see your doctor immediately. The doctor will order investigations which will include: blood tests, chest x-ray, echocardiogram, stress test, CT scan, MRI, coronary angiogram etc. Some doctors rely mostly on NT-proBNP testing to monitor patients with heart failure. You do not need to fast or do anything to prepare for the test. Levels go up when heart failure develops or gets worse, and levels go down when heart failure is stable. In most cases, BNP and NT-proBNP levels are higher in patients with heart failure than people who have normal heart function. The result helps your doctor determine if you have heart failure, if worsening fatigue or shortness of breath are due to heart failure or another problem or if heart failure has progressed toward end-of-life. It is important to note that this test is only one method your doctor uses to monitor your condition. Based on your results, your doctor can choose the best treatment plan for you.  Sixty-seven per cent of patients with unexplained shortness of breath did not need further diagnostic work-up after taking NT-proBNP test. A very useful test for patients with chronic unexplained shortness of breath.  The Canadian Cardiovascular Society recommends NT-proBNP screening to help confirm or rule out heart failure in patients with shortness of breath when clinical diagnosis remains uncertain. This can aid in decision-making and accelerate the path to appropriate referral. In Alberta, Laboratory Services has offered B-type natriuretic peptide or N-terminal proBNP testing in hospital laboratories across the province since 2012. Emergency Department physicians and cardiologists are able to order these tests to assist with diagnosing and treating heart failure. This test has improved quality of referrals to cardiologists and has reduced diagnostic delays. Treatment for heart failure: For most, heart failure is a long-term condition that can’t be cured. But treatment can help keep symptoms under control, possibly for many years. The main treatments are: healthy lifestyle changes, medications, devices implanted in your chest to control your heart rhythm, and surgery. Treatment will usually need to continue for the rest of your life. The life expectancy for congestive heart failure depends on the cause of heart failure, its severity, and other underlying medical conditions. In general, about half of all people diagnosed with congestive heart failure will survive five years. About 30 per cent will survive for 10 years. Dr. Bharwani is a general surgeon, freelance writer, photographer and author. 19-18
