Unit 11 The Heart and Circulation

Shortness of breath

Shortness of breath, or breathlessness, is dyspnoea. At first this is caused by exertion – physical activity such as climbing stairs – but in severe cases it may be present even at rest. A patient who is breathless when lying flat (orthopnoea), for example in bed, will tend to sleep raised up on two or more pillows. The abbreviation SOBOE stands for shortness of breath on exercise (or on exertion, or on effort).

Patients say:

Doctors can ask:

Heart rhythm

The normal resting heart rate is 65-75 beats per minute. In athletes in may be as low as 40 beats per minute. In extreme athletic activity, the heart rate can go as high as 200/min. The heart rhythm may be regular or irregular. In an irregular rhythm (arrhythmia), there may be early beats which interrupt the regular rhythm (premature beats); or the rhythm may vary with respiration; or it may be completely irregular, as in fibrillation. When patients are aware of irregularity, they describe the symptom as palpitations.

Case history

A 22-year-old student was admitted to hospital with a long history of heart problems. She had been increasingly tired, with shortness of breath on exertion, orthopnoea, and palpitations. A mitral valve replacement had been carried out 3 years previously and this had stabilized the symptoms of heart failure but was followed by episodes (attacks) of atrial fibrillation, which had been particularly severe for the 6 months before admission.

Heart failure

Heart failure occurs when the heart is unable to maintain sufficient cardiac output – the amount of blood pumped by the heart each minute – for the body’s needs. It may involve the left side of the heart, the right side, or both. In left heart failure the main symptom is breathlessness. The symptoms of right heart failure include peripheral oedema (swelling), beginning in the feet and ankles. This is known as pitting oedema if, when a finger is pushed into the swelling, it caused a small depression or pit.

Exercises:

1. Complete the conversation based on the case history in B.

Doctor: What seems to be the problem?

Patient: I’ve been getting (1) ……………………. .

Doctor: How long have you had them?

Patient: For about six months. But I’ve had heart problems for years, with tiredness and (2) ……………………. of (3) ……………………. . In the end I couldn’t walk more than a hundred metres without having to stop. I had to sleep on three (4)……………………. . I had a (5) ……………………. ……………………… replacement three years ago, and that improved things for a while.

2. Make word combinations using a word from each box. Two words can be used twice. Look at B and C to help you.

at atrial cardiac heart on pitting premature

output failure oedema fibrillation beats effort rest

3. Write the words a patient would use to describe the symptoms below. Look at A, B and C to help you.

1. dyspnoea

2. arrhythmia

3. orthopnoea

4. oedema

4.Complete the case report. Look at A, B and C to help you.

Case history

A 60-year-old woman attended her GP’s surgery complaining of breathlessness on (1) …………… . This had been increasing over the previous eight months until it was producting problems at around 500 metres walking on the level. There was no history of chest pain. She had had several (2) …………… of fast (3) …………… which lasted 20-30 minutes and were associated with some (4) …………… of breath. She had noticed some (5) …………… of her ankles by the end of the day. This disappeared overnight.