Breathlessness is a very common symptom in individuals with heart disease. The sensation can be described differently depending on the individual, and their circumstances, including shortness of breath, difficulty in breathing, heaviness in breathing and in more severe cases — fighting for breath, air hunger, or a sensation of drowning. The medical term, Dyspnoea, might also be used by your physician to describe breathlessness.

The sensation of a tight chest, discomfort or bandlike constriction in the chest can be a feature of breathlessness, however it is not very specific and raises the possibility of angina (a type of chest pain caused by reduced blood flow to the heart muscle). It is important that you can describe the circumstances in which you feel breathless.

A common experience is the sensation of breathlessness when exerting the body. Activities that you would normally manage without difficulty induce a sensation of breathlessness like those you would experience after more vigorous physical exertion. This might include climbing stairs or hills, gardening or even getting dressed.

The onset may be very gradual and, on occasion, you may have dismissed this difficulty in breathing as you get older, become out of condition or overweight. However, a change in your breathing noticed by your family or when you compare yourself to your peers might be significant.

Breathlessness at rest and at night

It is important to be able to recognise severe breathlessness, which occurs even at rest and may be associated with chest tightness or wheezing (a symptom more commonly associated with asthma or lung disease).

A sensation of breathlessness occurring when lying down prompting the use of multiple pillows or sleeping in a chair at night (also known as orthopnoea) is an indication that the hearts’ function has been significantly compromised and you should seek urgent medical care.

Waking up in the night with severe bouts of breathlessness which also improves when standing or sitting up on the edge of the bed (also known as paroxysmal nocturnal dyspnoea) are closely linked experiences and indicate that the lungs may be becoming congested and accumulating fluid (also known as fluid on the lung).

This congestion may be identified by your doctor when listening to your lungs or looking at a chest x-ray. These symptoms are not exclusively associated with atrial fibrillation and may be a symptom of any condition in which the heart function is compromised.

A sudden increase in breathlessness may also be noted when the heart first changes from a normal rhythm to atrial fibrillation. This may occur over a period of minutes to hours and could be associated with palpitations or a feeling of the heart racing.

Breathlessness occurring at rest can be distressing and will normally prompt you to seek urgent help from your doctor. Where atrial fibrillation is intermittent, lasting minutes or hours before spontaneously returning to a normal rhythm, the symptom of breathlessness may follow a similar pattern and between these episodes, breathing can be normal.

When reporting this symptom to your doctor you should take note of what factors may precipitate breathlessness and any associated features such as wheezing, palpitations, awareness of the heart racing or chest pain.

It is important to realise that breathlessness is a symptom of many medical conditions and that your doctor will need to exclude other causes such as valve disease, heart muscle disease, angina, or other medical conditions even if it has been established that you have atrial fibrillation.

For this reason, a number of further investigations may be required, including blood tests, an echocardiogram, exercise testing, and lung function tests.

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