DYSPNEA (Shortness of breath)

Dyspnea results from abnormalities of gas exchange (decreased oxygenation, hypoventilation, hyperventilation), and
increased work of breathing because of changes in respiratory mechanics and/or anxiety

Clinical occurrence

1. Decreased Fraction of Inspired Oxygen

a. High altitudes
2. Airway Obstruction
a. Larynx and Trachea infections
i. Laryngeal diphtheria
ii. Acute Laryngitis
iii. Epiglottitis
iv. Ludwig angina
b. Angioedema
c. Trauma
i. Hematoma
ii. Laryngeal edema
d. Neuropathic: Abductor paralysis of vocal cords
e. Foreign bodies
f. Tumors of the neck
i. Goiter
ii. Carcinoma
iii. Lymphoma
iv. Aortic aneurysm
g. Ankylosis of the cricoarytenoid joints
3. Bronchi and Bronchioles
a. Acute and chronic bronchitis
b. Asthma
c. Retrosternal goiter
d. Aspirated foreign bodies
e. Extensive bronchiectasis
f. Bronchial stenosis
4. Abnormal alveoli
a. Alveolar filling
i. Pulmonary edema
ii. Pulmonary infiltration
1. Infectious and aspiration pneumonia
2. Carcinoma
3. Sarcoidosis
4. Pneumoconioses
iii. Pulmonary hemorrhage
iv. Pulmonary alveolar proteinosis
b. Alveolar Destruction
i. Pulmonary emphysema
ii. Pulmonary fibrosis
iii. Cystic diseases of the lungs
c. Compression of the alveoli
i. Atelectasis
ii. Pneumothorax
 iii. Hydrothorax
iv. Abdominal distention
5. Restrictive Chest and Lung diseases
a. Paralysis of the respiratory muscles (esp. the intercostals and diaphragm)
b. Myasthenia gravis
c. Thoracic deformities
i. Kyphoscoliosis
ii. Thoracoplasty
d. Scleroderma or burns of the thoracic wall
e. Pulmonary fibrosis
6. Abnormal Pulmonary Circulation
a. Pericardial tamponade
b. Pulmonary artery stenosis
c. Arteriovenous shunts in heart and lungs
d. Pulmonary thromboembolism and infarction
e. Other emboli (fat, ari, amniotic fluid)
f. Arteriolar stenosis (Primary pulmonary hypertension, irradiation)
7. Oxyhemoglobin deficiency
a. Anemia
b. Carbon monoxide poisoning (carboyhemoglobinemia)
c. Methemoglobinemia
d. Sulfhemoglobinema
e. Cyanide and cobalt poisoning
8. Abnormal Respiratory stimuli
a. Pain from respiratory movement
b. Exaggerated consciousness of respiration (effort syndrome)
c. Hyperventilation syndrome
d. Secondary respiratory alkalosis (increased intracranial pressure, metabolic acidosis)

Paroxysmal dyspnea.

A transient increase in pulmonary capillary pressure is caused by redistribution of fluid from edematous extremities to the
lungs with recumbency, or ischemia-induced transient decreases in LV performance. Sudden paroxysms of breathlessness
often occur with recumbency or exertion. When sleep is interrupted, it is termed paroxysmal nocturnal dyspnea which
may be accompanied by orthopnea and coughing. The patient often finds that sitting or walking for a few minutes relieves
the dyspnea permitting sleep to resume.

Shortness of breath when lying down—orthopnea.

Redistribution of extracellular fluid from the periphery to the lungs, elevation of the diaphragm from obesity or ascites,
and muscular weakness all contribute to dyspnea when lying flat. The patient assumes a resting position with the head
and chest elevated; the severity is estimated by the number of pillows required to achieve a comfortable sleeping position.
Many patients awaken from sleep in the supine position severely short of breath (paroxysmal nocturnal dyspnea).
Orthopnea may be overlooked if not specifically ask about or if the patient is not observed for some time while supine.

Shortness of breath when standing up—platypnea.

Enlargement of pulmonary arteriovenous shunts leads to increased right to left shunting with standing. The results are
decreased oxygen saturation on standing (orthodeoxia) and shortness of breath. This is part of the hepatopulmonary
syndrome seen in patients with advanced liver disease. Patients complain of shortness of breath and weakness on
standing, relieved by sitting or lying. They have stigmata of advanced liver disease including cutaneous spiders and ascites
caused by portal hypertension.