Dyspnea
Ghadeer Ismail Eideh
Supervised by Dr. Ashraf Al Zughayyer.
21-sep-2022
From: step up to medicine

Definition and general
characteristics
Diagnosis Treatment
01
Causes
02
03 04
Outline

Definition and general
characteristics
01

Definition
Shortness of breath ,is often
described as an intense
tightening in the chest, air
hunger, difficulty breathing,
breathlessness or a feeling of
suffocation.

General Characteristics
1. Distinguish acute from chronic dyspnea which acute occurring over
hours to days and chronic occurring for more than 4 to 8 weeks.
2. Patients with chronic dyspnea usually have either heart or lung disease
or both. It may be difficult to distinguish between the two.
Depending on patient presentation, any of the following tests
may be helpful in distinguishing between lung and heart
diseases:
• CXR
• Sputum Gram stain and culture (if patient has sputum)
• PFTs
• ABGs
• ECG, echocardiogram

General Characteristics
3. The most common causes of acute dyspnea include CHF exacerbation,
pneumonia, bronchospasm, PE, and anxiety.
4. Assess the patient’s baseline level of activity, whether the dyspnea is
new in onset, and its association with exertion.
5. If the patient has a history of smoking, cough, sputum, repeated
infections, or occupational exposure, lung disease is likely to be the
reason for chronic dyspnea.
6. Dyspnea is a symptom of the disease, rather than a disease itself.

Sleep apnea and orthopnea

Causes
02

Psychiatric disease
Neuromascular
disease
Causes
Cardiovascular
cause
Pulmonary
causes
Systamic causes
Chest wall
abnormalities

Cardiovascular causes
01
CHF
02
Ischemic heart disease,
acute myocardial
infarction.
04
Arrhythmias.
05
Valvular disease.
03
Pericarditis, cardiac
tamponade.
06
Congenital heart
disease.

Pulmonary causes
01
Obstructive lung diseases—
COPD, asthma,
bronchiectasis
02
PE
04
Pneumonia, TB,
bronchitis
05
Pleural effusion,
pulmonary edema
03
ARDS

06
Upper airway
obstruction, foreign
body aspiration
07
ILD
09
Chest wall abnormalities
(kyphoscoliosis), rib
fracture
Pulmonary causes
Pneumothorax
08

Causes
3. Psychiatric disease—generalized anxiety disorder, panic attacks,
hyperventilation
4. Systemic causes—severe chronic anemia, sepsis, DKA, GERD,
medication (narcotic overdose)
5. Chest wall abnormalities—kyphoscoliosis, rib fracture, ankylosing
spondylitis
6. Neuromuscular diseases that weaken respiratory muscles—myasthenia
gravis, muscular dystrophy

Diagnosis
03

1.Thorough history and physical examination,
vital signs.
2. Pulse oximetry—normal is 96% to 100% on
room air. Be aware that the baseline oxygen
saturation of many COPD patients is
chronically low.
Diagnosis

3. ABG—may be indicated if oxygen
saturation is low on pulse oximetry, if
hypercarbia is suspected, or to
evaluate for acid–base abnormalities.
Diagnosis

4. CXR—can reveal pneumothorax, pleural effusion, pulmonary
vascular congestion secondary to CHF, infiltrates due to pneumonia,
ILD, and so on.
5. CBC—to evaluate for anemia, infection.
6. ECG—may show ventricular hypertrophy or evidence of ischemic
heart disease.
Diagnosis

7. Echocardiogram—for further evaluation of CHF, Valvular heart disease.
8. PFTs—perform if all of the above are normal or if obstructive lung
disease is suspected.
9. V/Q scan or spiral CT scan—perform if PE is suspected.
10. Bronchoscopy—indicated if foreign body aspiration is suspected.
Diagnosis

Treatment
04

1. Treat the underlying cause.
2. Use intubation and mechanical ventilation in the following situations:
a. If impending respiratory failure is suspected
b. If patient is unable to protect airway (e.g., decreased mental status,
stroke, drug overdose)
c. Severe hypoxia despite supplemental oxygen (PO2 50)
3. Exercise and conditioning may improve perception of dyspnea.
Treatment

Thank you.