Congestive heart failure in the context of Wheezing

Shortness of breath (SOB), known as dyspnea (in AmE) or dyspnoea (in BrE), is an uncomfortable feeling of not being able to breathe well enough. The American Thoracic Society defines it as "a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity", and recommends evaluating dyspnea by assessing the intensity of its distinct sensations, the degree of distress and discomfort involved, and its burden or impact on the patient's activities of daily living. Distinct sensations include effort/work to breathe, chest tightness or pain, and "air hunger" (the feeling of not enough oxygen). The tripod position is often assumed to be a sign.

Dyspnea is a normal symptom of heavy physical exertion but becomes pathological if it occurs in unexpected situations, when resting or during light exertion. In 85% of cases it is due to asthma, pneumonia, reflux/LPR, cardiac ischemia, COVID-19, interstitial lung disease, congestive heart failure, chronic obstructive pulmonary disease, or psychogenic causes, such as panic disorder and anxiety (see Psychogenic disease and Psychogenic pain). The best treatment to relieve or even remove shortness of breath typically depends on the underlying cause.

Hypervolemia, also known as fluid overload, is the medical condition where there is too much fluid in the blood. The opposite condition is hypovolemia, which is too little fluid volume in the blood. Fluid volume excess in the intravascular compartment occurs due to an increase in total body sodium content and a consequent increase in extracellular body water. The mechanism usually stems from compromised regulatory mechanisms for sodium handling as seen in congestive heart failure (CHF), kidney failure, and liver failure. It may also be caused by excessive intake of sodium from foods, intravenous (IV) solutions and blood transfusions, medications, or diagnostic contrast dyes. Treatment typically includes administration of diuretics and limit the intake of water, fluids, sodium, and salt.

Pulse pressure is the difference between systolic and diastolic blood pressure. It is measured in millimeters of mercury (mmHg). It represents the force that the heart generates each time it contracts. Healthy pulse pressure is around 40 mmHg. A pulse pressure that is consistently 60 mmHg or greater is likely to be associated with disease, and a pulse pressure of 50 mmHg or more increases the risk of cardiovascular disease. Pulse pressure is considered low if it is less than 25% of the systolic. (For example, if the systolic pressure is 120 mmHg, then the pulse pressure would be considered low if it were less than 30 mmHg, since 30 is 25% of 120.) A very low pulse pressure can be a symptom of disorders such as congestive heart failure.

William Withering FRS (17 March 1741 – 6 October 1799) was an English botanist, geologist, chemist, physician and first systematic investigator of the bioactivity of digitalis.

Withering was born in Wellington, Shropshire, the son of a surgeon. He trained as a physician and studied medicine at the University of Edinburgh Medical School. He worked at Birmingham General Hospital from 1779. The story is that he noticed a person with dropsy (swelling from congestive heart failure) improve remarkably after taking a traditional herbal remedy; Withering became famous for recognising that the active ingredient in the mixture came from the foxglove plant. The active ingredient is now known as digoxin, after the plant's scientific name. In 1785, Withering published An Account of the Foxglove and some of its Medical Uses, which contained reports on clinical trials and notes on digitalis's effects and toxicity.