SHORTNESS OF BREATH (DYSPNEA)

Shortness of breath is an unpleasant subjective awareness of the sensation of breathing. Patient usually feels discomfort either from increased ventilatory drive or reduced ventilatory capacity.

Increased ventilatory drive causing increased respiratory rate occurs in:

• Fever
• Exercise
• Acidemia: ketoacidosis, lactic acidosis, uremia
• Hypoxia: asthma, COPD, cyanotic heart diseases.
• Hypercarbia: COPD

Reduced ventilatory capacity occurs in:

• Reduced lung volume in pneumonia, pulmonary edema and interstitial lung disease
• Pleural pain
• Increased resistance to airflow in asthma, COPD, laryngeal obstruction.

PATIENT EVALUATION

History

• Ask about cardiac and respiratory risk factors such as:
• Diabetes, hypertension, smoking for heart disease
• Asthma, COPD and tuberculosis for respiratory disease
• Renal disease for uremia
• Medication for lactic acidosis
• History of previous similar episodes and their diagnosis
• Associated features such as palpitation, syncope, chest pain, nausea, vomiting and sweating are cardiac manifestations while cough, chest pain related to breathing, sputum are features of respiratory disease and low urine output and anemia indicate renal disease.
• In acute, dyspnea, rule out cardiac failure, heart block, MI, angina, pulmonary embolism, pneumothorax and laryngeal edema.
• Chronic dyspnea is progressive i-e patient’s working capacity gradually decrease. Chronic episodic dyspnea occurs in asthma, heart failure, acute or chronic bronchitis and recurrent pulmonary embolism. Chronic constant dyspnea occurs in COPD, pulmonary fibrosis and pulmonary hypertension.

Examination

Quick and relevant examination related to cardiac disease such as pulse showing tachycardia, bradycardia, irregular pulse, displaced apex beat, murmurs and basal crepts.

Respiratory examination such as rapid respiratory rate, abnormal percussion note, wheeze, crepts or pleural rub.

Investigations

ECG, chest X-ray, ABGs, RBS, urea and creatinine are usually enough for diagnosis.

Shortness of breath
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