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