This is a terrifying symptom for the patient, and the subjective feeling of shortness of breath is not predictably related to the type or degree of pathology. This, combined with the fact that the cause is often organic, means that a careful and urgent assessment is mandatory.
Acute chest pain is a regular visitor to general practice: It may generate more adrenaline in the physician than the patient. In spite of a constellation of causes, a good basic clinical approach will determine the diagnosis in nearly all cases, long before any necessary investigations are complete.
Shortness of breath is defined as difficult, laboured breathing. Medical teaching tends to focus on individual pathologies; however, in practice there is often some overlap between several contributory causes and sometimes the diagnosis can only be made after therapeutic trials of treatment.
This is a symptom that patients seem to fear or value – as a signifier of possible cancer or a justifier of antibiotics – far more than GPs. Most coughs are simply viral URTIs, but the GP should be aware of the various other possibilities, especially when the symptom is persistent.
The symptom GPs love to hate because it can appear so trivial. Reassurance and explanation are often all that is required, and this can build a bond with parents and children. Take parents seriously and sympathetically: Nocturnal cough is a destroyer of sleep and family peace.
Patients invariably view this relatively uncommon symptom as representing something serious – this is rarely the case in primary care. In practice, the origin of the blood may not be immediately obvious: Quite often, blood from the nose or throat may be coughed out with saliva (spurious haemoptysis) and described as ‘coughing up blood’.
Palpitations are presented fairly frequently to the GP, sometimes in isolation but more often immersed in other symptoms. Patients use the word ‘palpitations’ to describe a remarkable variety of sensations, and it is important to establish exactly what is meant. Cardiac causes are relatively rare; anxiety about a cardiac problem, and anxiety as a cause of the symptom, are common.