Chapter 18 - Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99) » Symptoms and signs involving the circulatory and respiratory systems (R00-R09) » Dyspnea (R06.0)
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Dyspnea is a symptom, a sensation, or a complaint of the patient in which the patient has enough or has to breathe too much, or, simply, an abnormal, uncomfortable feeling during breathing. It's also called shortness of breath (1).
Exertional dyspnea is the most common symptom of respiratory, cardiac, psychogenic, neuromuscular, or systemic illnesses, or a combination of these.
The sensation of dyspnea mostly comes in patients when their body is lacking oxygen delivery.
Dyspnea on Exertion Causes
Dyspnea on exertion is a symptom or a complaint of various diseases rather than a disease itself.
Dyspnea on exertion arising from:
- The respiratory system.
- The cardiac system.
- Other systemic illnesses or combinations of different etiologies.
There are three main causes including (2)
1. Respiratory causes
- Asthma
- Acute exacerbation of chronic obstructive pulmonary disorder (COPD)
- Pneumonia
- Pulmonary embolism
- Lung malignancy
- Pneumothorax, or aspiration
2. Cardiovascular causes
- Congestive heart failure
- Pulmonary edema
- Acute coronary syndrome
- Pericardial tamponade
- Valvular heart defect
- Pulmonary hypertension
- Cardiac arrhythmia
- Intracardiac shunting
3. Systemic Causes
- Anemia
- Acute renal failure
- Metabolic acidosis
- Thyrotoxicosis
- Cirrhosis of the liver
- Anaphylaxis
- Sepsis
- Angioedema
- Epiglottitis
The most common cause of dyspnea on exertion (DOE) is congestive heart failure (CHF).
Dyspnea on Exertion Symptoms
Signs & symptoms that a person is experiencing dyspnea on exertion include:
- Shortness of breath
- Labored breathing
- Tightness in the chest
- Rapid, shallow breathing
- Wheezing
- Coughing
- Uncomfortable or difficult breathing
- Chest tightness
- A sensation of suffocating or gasping or gulping for air
- Anxiety and fear
Signs & symptoms that a person is experiencing dyspnea on exertion of varying intensities and durations. If symptoms are severe or occur suddenly, it may be a sign of a serious medical condition.
When dyspnea occurs during intense exercise, it typically improves upon rest.
While some people may develop it from simple activities, such as
- Walking
- Sitting still
- Going up steps
- Jogging
Why does Dyspnea on Exertion happen?
One research study found that the sensation of dyspnea upon exertion occurs due to signal interactions between the:
- Central nervous system (CNS)
- Peripheral chemoreceptors
- Mechanoreceptors in the chest wall and respiratory tract
Dyspnea on Exertion icd 10
The following icd 10 code for dyspnea on exertion (3).
| R06 | Abnormalities of breathing |
| R66.0 | Dyspnea / Dyspnea on Exertion |
Approximate Synonyms of Dyspnea
- Paroxysmal nocturnal dyspnea
- Respiratory distress
- Shortness of breath
ICD 10 dyspnea on exertion Clinical Information
Its characterized by an uncomfortable sensation of difficulty breathing.
- An uncomfortable sensation of difficulty breathing. It may present as an acute or chronic sign of an underlying respiratory or heart disorder.
- Difficult or labored breathing.
- Difficult, painful breathing or shortness of breath.
- Difficulty in breathing which may or may not have an organic cause.
- Labored or difficult breathing is associated with a variety of disorders, indicating low blood oxygen, inadequate ventilation, or a subjective experience of breathing discomfort.
Dyspnea on Exertion Diagnosis
The doctor suggests different tests for the diagnosis of dyspnea on exertion depending on its underlying causes.
The doctor can differentiate acute dyspnea on exertion vs chronic dyspnea based on its causes
Acute dyspnea on exertion is most likely caused by:
- Acute myocardial ischemia
- Heart failure
- Pulmonary embolism
- Pneumothorax
- Cardiac tamponade
- Bronchitis or pneumonia
- Upper airway obstruction or anaphylaxis
Chronic dyspnea is most likely caused by:
- Asthma
- Chronic obstructive pulmonary disease
- Interstitial lung disease
- Myocardial dysfunction
- Congestive heart failure
- Obesity
- Deconditioning
Dyspnea on Exertion Treatment
The doctor gives treatment for dyspnea on exertion depending on its underlying causes.
A doctor may also recommend making changes to everyday habits, such as:
- Taking iron, folic acid, vitamin B12, and vitamin C supplements
- Avoiding alcohol intake
- Avoiding smoking
- Avoiding tobacco
- Managing diabetes or metabolic syndrome
- Maintaining a proper body weight
- Eating a healthful & balanced diet
- Take a diet that is rich in sources of iron, such as dark leafy greens, beans and pulses, dried fruits, and fortified products
When to Visit a Doctor?
A person should visit a doctor when they experience frequent dyspnea or the following symptoms accompany dyspnea upon exertion:
- High fever or chills or Nausea
- Loss of consciousness or unexplained sleepiness
- Chest pressure or chest pain
- Irregular heartbeat
- Severe or worsening cough with or without mucus
- Bluish or discolored skin, starting at the lips and fingertips
- The increased urinary frequency at night
- Reduced urination
- Irregular menstruation
- Swelling in the abdomen, legs, ankles, or feet
- Unexplained exhaustion
- Coughing up blood
- Swelling of the tongue, lips, mouth, or throat
- Swelling with a rash
- Unexplained weakness
- Chronic lack of appetite
- Unexplained weight loss
- Bruising more easily than usual
- Pale or yellowish skin
- Dizziness
- Cold hands and feet
- Confusion
- Unexplained itchy skin
- Severe sore throat and trouble swallowing
- Abnormal, high-pitched breathing sounds
Which Speciality Doctor Consulting for DOE
Based on possible underlying Causes after the initial evaluation, different following specialties need to be consulted (2):
- Pulmonologist
- Cardiologist
- Interventional Radiologist
- Interventional Cardiologist
- Thoracic Surgeon
Summary
Many people experience the sensation of breathlessness or difficulty in breathing while they are exercising however it is often harmless and goes away with rest.
Some people show dyspnea on exertion during exertion as a sign of an underlying respiratory, cardiac, or systemic condition, many of which require medical attention or emergency care.
Dyspnea on exertion is harmless and a normal physiological finding however, people must consult a doctor when dyspnea on exertion is unexplained, sudden, severe, or disabling.