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Advanced Diagnostics & Care for Dyspnea Patients

Unexplained dyspnea, also known as shortness of breath, affects people of all ages and lifestyles while at rest and/or during exercise. It can be caused by many different heart, lung and/or neuromuscular conditions, making diagnosis challenging.

Physicians around the world regularly refer patients with complicated or hard-to-diagnose conditions to the Mass General Dyspnea Clinic. One reason is our staff, which includes a board-certified pulmonologist and exercise physiologist who has specialized in dyspnea during exertion for over two decades.

Additionally, several of the advanced diagnostics we use at the clinic were developed by our team and are not offered at any another hospital. An example is advanced cardiopulmonary exercise testing, which we use to identify disorders that have proven difficult or impossible to diagnose in patients tested at rest.

What to Expect

When your physician has been unable to diagnose the reason for your dyspnea during exercise, it may be appropriate for you to be seen at the Dyspnea Clinic. Patient care begins with an evaluation at the clinic, which is open Mondays from 8 a.m. to noon and located on Cox 2 at our downtown Boston campus. Please let us know if you are traveling a long distance, and we will make every effort to schedule your evaluation on another day, if necessary.

Before your initial evaluation, please ask your referring physician to send us your medical records and any test results, including CDs of chest images. During the appointment, our specialists will review your medical history and family history and perform a physical examination.

If a comprehensive evaluation and routine tests don't lead to a diagnosis, we usually recommend additional testing at the Mass General Cardiopulmonary Exercise Lab, located nearby on Bigelow 9. At the lab, we will test the function of your heart, lungs and/or limb muscles while you are at rest and while you pedal a stationary cycle ergometer. All tests are supervised by an experienced pulmonologist, three technologists and a nurse practitioner.

We perform two types of exercise tests at the exercise lab: a basic, noninvasive test (Level 1) and an advanced, invasive test (Level 3):

Level 1 Test: For this method, we fit you with several EKG leads and insert a small catheter into a vein in your arm. The test takes about two hours, and you will be able to leave the hospital immediately after the test

Level 3 Test: Please plan on spending about four hours with us. This test involves the insertion of two catheters under sterile conditions and guided by ultrasound. Most patients are ready to leave about an hour after the test, but we do require a friend, family member or caregiver to drive the patient home

The Advantage of Integrated, Multidisciplinary Care

When we determine a patient's dyspnea is caused by a pulmonary disorder, we develop the patient's personalized treatment plan and manage his or her follow-up care. Dyspnea, however, sometimes affects not only the pulmonary system, but also the cardiovascular and/or neuromuscular systems.

To ensure patients receive outstanding, comprehensive care, your care team may include other specialists in the Pulmonary and Critical Care Unit along with other clinical departments at Mass General, such as:

In addition, we refer some patients with upper-airway obstructions and problems such as vocal-cord damage to the nearby Massachusetts Eye and Ear.

A History of Excellence

Mass General has focused on diagnosing and managing care for patients with unexplained dyspnea, also known as shortness of breath, for over 30 years. Our program and clinic are staffed by a board-certified pulmonologist who has dedicated his career to specializing in treating and studying dyspnea. Several of the advanced diagnostics and therapies we administer at the Dyspnea Clinic are offered only at Mass General, including those used in evaluating patients who experience shortness of breath while exercising.

Diagnosing dyspnea often is extremely challenging because the disorder can be caused by problems (some of which are relatively rare) with the pulmonary, cardiovascular and/or neuromuscular systems. These include:

  • Neuromuscular diseases affecting the respiratory system and/or limb muscles, including oxidative myopathy
  • Exercise-induced mitral regurgitation
  • Diastolic heart failure during exercise
  • Pulmonary hypertension during exercise
  • Upper-airway disorders, including vocal-cord dysfunction
  • Experts in the Diagnosis and Care of Dyspnea Patients

The Mass General Dyspnea Program is led by Gregory Lewis, MD, who is board-certified in internal medicine and cardiovascular disease. Dr. Lewis also directs the Mass General Cardiopulmonary Exercise Lab, where he and his team test dyspnea patients using some of the most sophisticated diagnostics available.

Advancing Care Through Research

The goals of our research are to better understand the causes of dyspnea, facilitate patient diagnoses in a less invasive manner and develop novel treatments that help patients enjoy a better quality of life. Our research accomplishments include:

  • Using 31P magnetic resonance spectroscopy at the Martinos Center for Biomedical Imaging, we discovered skeletal muscle mitochondrial dysfunction in patients with chronic lung disease, including patients with pulmonary hypertension and those who have had lung transplantation
  • Our team developed the first description of exercise-induced pulmonary hypertension as a clinically relevant cause of unexplained dyspnea
  • A study into the emerging field known as metabolomics conducted by Gregory Lewis, MD, demonstrated the normal footprint of metabolites in the blood during exercise. Published in the world-renowned journal Science, the findings eventually may lead to using biomarkers instead of invasive procedures to detect pulmonary hypertension, exercise-induced heart failure and other conditions that can cause dyspnea