Review Article| Volume 90, ISSUE 3, P453-479, May 2006

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  • Joseph R. Shiber
    Corresponding author. Department of Medicine, East Carolina University, 600 Moye Boulevard, Greenville, NC 27834.
    Department of Medicine, East Carolina University, Greenville, NC, USA

    Department of Emergency Medicine, East Carolina University, Greenville, NC, USA

    Emergency Medicine–Internal Medicine Combined Residency, East Carolina University, Greenville, NC, USA
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  • Jose Santana
    Department of Emergency Medicine, East Carolina University, Greenville, NC, USA
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      The sensation of breathlessness, dyspnea, is clinically important when it is recognized by the patient as abnormal. The development of shortness of breath (SOB) or the inability to satisfy oxygen requirements is an expected outcome of overexertion, such as occurs after running or heavy lifting. When dyspnea occurs at rest or during exertion that is less than expected, it is considered pathologic and a symptom of a disease state. Multiple organ systems are involved in the differential diagnosis of dyspnea, most commonly the cardiovascular and pulmonary systems. The type and severity of underlying lung or heart disease have been shown to correlate with the description offered by the patient [
      • Zoorob R.J.
      • Cambell J.S.
      Acute dyspnea in the office.
      • Kunitoh H.
      • Wantanabe K.
      • Sajima Y.
      Clinical features to predict hypoxia and/or hypercapnea in acute asthma attacks.
      ]. Box 1 illustrates the extensive differential diagnosis for dyspnea.
      Differential diagnosis for dyspnea

        Mechanical interference with ventilation

      • Abdominal or chest mass
      • Asthma, emphysema, bronchitis
      • Endobronchial tumor
      • Interstitial fibrosis of any cause
      • Kyphoscoliosis
      • Left ventricular failure
      • Lymphangitic tumor
      • Obesity
      • Obstruction to airflow, central or peripheral
      • Pleural thickening
      • Resistance to expansion of the chest wall or diaphragm
      • Resistance to expansion of the lung
      • Thoracic burn with eschar formation
      • Tracheal or laryngeal stenosis

        Weakness of the respiratory pump

      • Absolute
      • Hyperinflation
      • Neuromuscular disease
      • Obesity
      • Pleural effusion
      • Pneumothorax
      • Previous poliomyelitis
      • Relative

        Increased respiratory drive

      • Decreased cardiac output
      • Decreased effective hemoglobin
      • Hypoxemia of any cause
      • Metabolic acidosis
      • Renal disease
      • Stimulation of intrapulmonary receptors

        Wasted ventilation

      • Capillary destruction
      • Large-vessel obstruction

        Psychologic dysfunction

      • Anxiety
      • Bodily preoccupation, somatization disorder
      • Depression
      • Secondary gain, malingering
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