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 [
1
,
2
]. Box 1 illustrates the extensive differential diagnosis for dyspnea.
Box 1
Differential diagnosis for dyspnea
-
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
Mechanical interference with ventilation
-
Absolute
-
Hyperinflation
-
Neuromuscular disease
-
Obesity
-
Pleural effusion
-
Pneumothorax
-
Previous poliomyelitis
-
Relative
Weakness of the respiratory pump
-
Decreased cardiac output
-
Decreased effective hemoglobin
-
Hypoxemia of any cause
-
Metabolic acidosis
-
Renal disease
-
Stimulation of intrapulmonary receptors
Increased respiratory drive
-
Capillary destruction
-
Large-vessel obstruction
Wasted ventilation
-
Anxiety
-
Bodily preoccupation, somatization disorder
-
Depression
-
Secondary gain, malingering
Psychologic dysfunction
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Further readings
- A rapid quantitative D-dimer assay at admission correlates with the severity of community acquired pneumonia.Blood Coagul Fibrinolysis. 2003; 14: 745-748
- Clinical, laboratory, roentgenographic and electrocardiographic findings in patients with acute pulmonary embolism and no pre-existing cardiac or pulmonary disease.Chest. 1991; 100: 598
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