It is very common in pregnancy, with the majority of women experiencing breathlessness at some time during their pregnancy.
Physiological: This is an isolated symptom which occurs as a result of the physiological hyperventilation of pregnancy, leading to a subjective feeling of shortness of breath. It is very common in the third trimester and occurs at rest or while talking and may improve during mild activity.
Pathological: This type of breathlessness occurs in conjunction with other symptoms of cardiorespiratory disease. It is persistent and interferes with daily activities.
Key Pointers to Specific Conditions
Pneumonia: Smoking, upper respiratory tract infection (URTI), immunosuppression, drugs, for example, steroids, chronic lung disease, recent hospitalisation or surgery
Asthma: Exercise, stress, emotion, wheeze, cold air, acid reflux, polyarteritis nodosa, vasculitis, eczema and other atopic diseases
Cardiac failure: Exertional dyspnoea, orthopnoea, paroxysmal nocturnal dyspnoea, nocturnal cough, wheeze and peripheral oedema
Key Diagnostic Signs
Pneumonia: Fever, tachycardia, cyanosis, productive cough, tachypnoea and rhonchi
Asthma: Tachypnoea, tachycardia, cyanosis, polyphonic wheeze, hyperinflation, diminished air entry or silent chest
Cardiac failure: Raised jugular venous pressure (JVP), cyanosis, hypotension, tachycardia, gallop rhythm, narrow pulse pressure, pleural effusion, bibasal crepitations, wheeze, tachypnoea, cardiomegaly and hepatomegaly
|Symptom/sign||Cardiac failure||Asthma||Pulmonary embolism||Pneumonia|
|Lungs||Bibasal crepitations||Expiratory rhonchi ↓ air entry/silent chest||—||Rhonchi|
|Heart sounds||Gallop rhythm||—||3rd HS||—|
|Blood pressure||Low||—||↓ /N||—|
|Pulse||↓ Volume, pulsus alterans||Pulsus paradoxus||N||N|
|Pulse rate||↑||↑ /N||↑ /N||↑ /N|
|Investigation||Cardiac failure||Asthma||Pulmonary embolism||Pneumonia|
|Chest radiograph||Hilar shadowing, Kerley B lines, cardiomegaly, pleural effusion||Hyperinflated lungs||Wedge-shaped opacity, pleural effusion, atelectasis, areas of translucency in underperfused lung||Patchy/consolidation|
|Electrocardiography||Left ventricular strain/enlargement||N||Right axis deviation, right bundle branch block, peaked waves in lead II, S1 Q3 T3 pattern||N|
|Echocardiogram||Cardiomegaly, ↓ ejection fraction, +/− valve abnormality valve abnormally||N||Right-sided strain||N|