Dyspnea: Differential Diagnosis

Cyril Štěchovský

Dept. of Cardiology 2.LF UK a FNM

Dyspnea

• Symptom – shortness of breath• Sign – abnormal respiratory effort

Dyspnea is a symptom of disorder at different levels•Central nervous system•Ventilation•Diffusion•Pulmonary perfusion•Oxygen transportation•Cellular oxygenation

Central disorders

• Hypoxemia• Hypercapnia• Stroke• Encephalitis• Tumor• Intoxication• Anxiety

Disorders of ventilation and diffusion

• Neuromuscular disorders• Trauma• Exhaustion• Airway obstruction

– Laryngospasm– COPD– Bronchial asthma– Tumor– Foreign body

• Restrictive pulmonary disorders - fibrosis

• Atelectasis• Pneumonia• Pulmonary congestion / edema• Fluidothorax• Pneumothorax• Esophageal hernia• Pulmonary resection• Chest deformity• High diaphragm

Disorders of pulmonary perfusion

• Pulmonary embolism• Pulmonary hypertension

Disorders of oxygen transportation and utilization

• Anemia• Methemoglobinemia• Carboxyhemoglobinemia• Cyanide intoxication

Others

• Pain• Decondition• Hyperthyreosis• Fever

Pulmonary edema• Fluid excess in pulmonary interstitium and

alveoli

Pulmonary edema

• Cardiac – increased LVEDP (PCWP)• Noncardiac (ARDS) – inflammation, „leaky“

alveolocapillary membrane– Inhaled toxins, aspiration, sepsis, oxygen toxicity,

pancreatits, traumatic shock

DDx

• History• Physical examination– Paleness (anemia), cyanosis– Respiratory rate, heart rate, BP, body temperature– Respiratory effort– Lungs and heart auscultation – Peripheral edema

• Pulse oximetry• Chest x-ray

DDx

• Complete blood count• ECG• Arterial blood gases• ECHO• Spirometry• Chest CT scan• Spiroergometry

Arterial blood gases analysis

• pH• Saturation• pO2• pCO2• Bicarbonate• Lactate• Anion gap• Base excess• Hemoglobin