How do I know whether the shortness of breath comes from the lungs or the heart?

This often cannot be determined with certainty from the outside, as both can cause similar symptoms. The doctor will narrow down the cause with targeted examinations such as listening to the chest, pulmonary function tests, ECG, and imaging if necessary.

Can shortness of breath also have psychological causes?

Yes. Stress, anxiety, and tension can lead to rapid, shallow breathing and a distressing feeling. Because this is difficult to distinguish from physical causes, medical assessment is advisable.

What can I do during an episode of breathlessness?

Sit upright, try to breathe calmly and slowly, and avoid triggers. If the shortness of breath persists or worsens, you should seek medical help.

Shortness of Breath — Causes, Assessment & the Right Specialty

Shortness of breath describes the distressing feeling of not getting enough air. It can originate from the lungs, the heart, allergies, or even tension, and ranges from mild, exertion-related breathlessness to a serious condition. The temporal pattern and accompanying circumstances are crucial for assessment: whether it increases gradually or occurs suddenly, at rest or only during exertion. Because the causes are so varied, persistent or unexplained shortness of breath should be evaluated by a doctor.

Possible causes

Airways and lungs

Infections, asthma, or other lung diseases can make breathing difficult, often accompanied by coughing or wheezing. Symptoms are frequently related to exertion or specific triggers.

Heart and circulation

The heart can also be behind shortness of breath, for instance when it can no longer pump blood adequately. Typical signs are then breathlessness on exertion, swollen legs, or breathlessness at night when lying down.

Allergy and tension

Allergic reactions can narrow the airways, while stress and anxiety lead to rapid, shallow breathing. Both feel distressing and should be assessed according to how they develop.

Rare but urgent

A pulmonary embolism causes sudden shortness of breath, often with chest pain that worsens with breathing and a racing heart. In a pneumothorax, air escapes into the pleural space and the lung partially collapses — sudden one-sided pain with breathlessness. Severe pneumonia, fluid in the lungs due to heart failure, and pronounced anemia can also cause shortness of breath. Sudden-onset shortness of breath must always be assessed by a doctor immediately.

Typical steps at the doctor's office

1The doctor first asks about the time course and circumstances — sudden or gradual, at rest or on exertion — and listens to the lungs and heart to determine the direction of further assessment.
2Depending on the suspected cause, further tests follow, such as measuring oxygen levels, a lung function test, an ECG, or an X-ray, to distinguish lung from heart causes.
3Treatment depends on the underlying cause. Once this is identified, breathing can in many cases be improved in a targeted and effective way.

What makes serious causes more likely

Smoking, known COPD, or asthma increase the likelihood of a cause in the airways.
Prolonged bed rest or immobilization, a recent surgery, a long journey, cancer, pregnancy, taking the pill, and previous blood clots point to a pulmonary embolism.
Known heart disease, high blood pressure, or atrial fibrillation point to a cause in the heart.
A pneumothorax occurs more frequently in tall, slim young men and in people with pre-existing lung disease.

What typically happens next?

Shortness of breath due to a respiratory infection usually improves within one to two weeks. In asthma and COPD, shortness of breath can generally be well controlled with the right treatment, but may temporarily worsen during an infection. In heart failure, the course depends on treatment; a sudden increase in shortness of breath, rapid weight gain, or swollen legs suggest worsening and should be assessed by a doctor. If shortness of breath increases over weeks or occurs with ever less exertion, further assessment is needed.

What you can do yourself

With mild, known shortness of breath, stay as calm as possible and sit upright — an upright posture makes breathing easier.
Breathe deliberately, slowly, and evenly; hurried, shallow breathing often makes the feeling of breathlessness worse.
Avoid known triggers such as smoke, dust, or strenuous exertion until the cause has been clarified.
Pay attention to accompanying symptoms and how they develop, so you can describe them accurately during the medical assessment.

When a doctor's visit makes sense

Have any newly occurring, increasing, or unclear shortness of breath medically assessed, especially if it already occurs with mild exertion or at rest. If it occurs together with chest pain, swollen legs, or cold sweat, it needs to be assessed the same day — in case of severe or sudden shortness of breath, call 144 immediately.

Frequently asked questions

How do I know whether the shortness of breath comes from the lungs or the heart?: This often cannot be determined with certainty from the outside, as both can cause similar symptoms. The doctor will narrow down the cause with targeted examinations such as listening to the chest, pulmonary function tests, ECG, and imaging if necessary.
Can shortness of breath also have psychological causes?: Yes. Stress, anxiety, and tension can lead to rapid, shallow breathing and a distressing feeling. Because this is difficult to distinguish from physical causes, medical assessment is advisable.
What can I do during an episode of breathlessness?: Sit upright, try to breathe calmly and slowly, and avoid triggers. If the shortness of breath persists or worsens, you should seek medical help.

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