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Dyspnea is a sensation, a symptom, a complaint on the part of the patient of not being

able to breathe enough or having to breathe too much, or, simply, an abnormal, uncomfortable

feeling during breathing (Wasserman, 1982)

While shortness of breath is generally caused by disorders of the cardiac or respiratory

system, other systems such as neurological, musculoskeletal, endocrine, hematologic, andpsychiatric may be the cause Diagnosis!ro, an online medical e"pert system, listed #9$ distinct

causes in %ctober 2&1& 'he most common cardiovascular causes are acute myocardial infarction

and congestive heart failure hile common pulmonary causes include chronic obstructive

pulmonary disease, asthma, pneumothora", pulmonary edema and pneumonia %n a

pathophysiological basis the causes can be divided into (1) an increased aareness of normal

breathing such as during an an"iety attack, (2) an increase in the ork of breathing and (*) an

abnormality in the ventilator system

Dyspnea that is greater than e"pected ith the degree of e"ertion is a symptom of

disease +ost cases of dyspnea result from asthma, heart failure and myocardial ischemia,

chronic obstructive pulmonary disease, interstitial lung disease, pneumonia, or psychogenicdisorders 'he etiology of dyspnea is multi factorial in about onethird of patients 'he clinical

presentation alone is ade-uate to make a diagnosis in .. percent of patients ith dyspnea

!atients/ descriptions of the sensation of dyspnea may be helpful, but associated symptoms and

risk factors, such as smoking, chemical e"posures, and medication use, should also be

considered 0"amination findings (eg, ugular venous distention, decreased breath sounds or

heeing, pleural rub, clubbing) may be helpful in making the diagnosis 3nitial testing in

patients ith chronic dyspnea includes chest radiography, electrocardiograph, spirometer,

complete blood count, and basic metabolic panel +easurement of brain natriuretic peptide levels

may help e"clude heart failure, and D dimer testing may help rule out pulmonary emboli

!ulmonary function studies can be used to identify emphysema and interstitial lung diseases

4omputed tomography of the chest is the most appropriate imaging study for diagnosing

suspected pulmonary causes of chronic dyspnea 'o diagnose pulmonary arterial hypertension or

certain interstitial lung diseases, right heart catheteriation or bronchoscopy may be needed

(W567, 2&12 ul 1:)

5cute dyspnea is most commonly caused by respiratory and cardiac disorders %ther

causes may be upper airay obstruction, metabolic acidosis, a psychogenic disorder, or a

neuromuscular condition Differential diagnoses in children include bronchiolitis, croup,

epiglottitis, and foreign body aspiration !ertinent history findings include cough, sore throat,

chest pain, edema, and orthopnea 'he physical e"amination should focus on vital signs and the

heart, lungs, neck, and loer e"tremities ignificant physical signs are fever, rales, heeing,cyanosis, stridor, or absent breath sounds

5cute dyspnea has multiple causes Dyspnea can be the first manifestation of a life

threatening disease or it can have a functional cause 'he most common causes of acute dyspnea

are pulmonary and cardiac diseases, as ell as acute blood loss, metabolic acidosis, an"iety, poor

physical condition 5cute dyspnea has multifactorial causes so that additional medical history

findings such as the presence of fever, night seats, chills, eight loss, chest pain, and recent

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trauma, history of a recent pro"imal deep venous thrombosis or symptoms of gastroesophageal

reflu" disease can help the practitioner to make the right diagnosis (7ighean et al, 2&&.)

4hronic dyspnea is defined as dyspnea lasting more than one month 3n appro"imately

to thirds of patients presenting ith dyspnea, the underlying cause is cardiopulmonary disease

0stablishing an accurate diagnosis is essential because treatment differs depending on the

underlying condition 5sthma, congestive heart failure, chronic obstructive pulmonary disease,

pneumonia, cardiac ischemia, interstitial lung disease, and psychogenic causes account for 8:

percent of patients ith this principal symptom 'he history and physical e"amination should

guide selection of initial diagnostic tests such as electrocardiogram, chest radiograph, pulse

o"imetry, spirometry, complete blood count, and metabolic panel 3f these are inconclusive,

additional testing is indicated ;ormal pulmonary function testing may be needed to establish a

diagnosis of asthma, chronic obstructive pulmonary disease, or interstitial lung disease 6igh

resolution computed tomography is particularly useful for diagnosing interstitial lung disease,

idiopathic pulmonary fibrosis, bronchiectasis, or pulmonary embolism 0chocardiography and

brain natriuretic peptide levels help establish a diagnosis of congestive heart failure 3f the

diagnosis remains unclear, additional tests may be re-uired 'hese include ventilation perfusionscans, 6olter monitoring, cardiac catheteriation, esophageal p6 monitoring, lung biopsy, and

cardiopulmonary e"ercise testing (, 2&&:)

Wasserman,