A couple thoughts on dyspnea and anxiety:
"Is the patient dyspneic because they're anxious, or are they anxious because their doctor can't figure out why they're dyspneic?"
- Walter O'Donnell
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Dyspnea and anxiety coexist frequently because there's nothing like a pulmonary embolism, coronary clot, bronchospasm, or another reason for breathlessness to make you anxious.
Don't invoke anxiety as a cause until you have well considered a thorough differential.
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Once you have considered/ruled out cardiopulmonary and metabolic causes and are still considering anxiety as a cause, there are two clues I have found helpful to support that hypothesis:
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If dyspnea occurs at rest and improves with exertion - it may be from anxiety.
Go for a walk with the patient, have an engaged conversation, observe breathing pattern and symptoms.
Note: this is more relevant for mild-moderate dyspnea, not a panic attack.
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If dyspnea is described as a feeling of needing/trying to take a deep satisfying breath but not being able to - it may be from anxiety.
We all take such "sigh” breaths periodically, and finally achieving one often temporarily relieves dyspnea from anxiety.
Please share!
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