Clinical approach to patient with dyspnea

Dyspnea is the subjective sensation of shortness of breath, which may be

discomfort or an abnormal awareness of breathing.
Dyspnea can occur as a consequence of increased work of breathing or when
there is stimulation of respiratory centers in the brainstem or receptors
throughout the respiratory system.

Notes: -
1- Acute dyspnea should be evaluated urgently and this approach can be later
used after the patient is stabilized

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2- History and PE should guide further steps and help you focus on one
system, some associated symptoms and physical signs for each system
include:

Hx findings and
Involved System Signs
Symptoms
Pursed lip breathing, Barrel
Cough, Hemoptysis, Hx of chest, decreased chest
Pulmonary Smoking/occupational expansion, dullness on
exposures percussion, Wheezes,
Crackles
Cheyne-Stokes breathing,
Elevated JVP, S3 or S4 on
Cardiac Exertional dyspnea, Chest pain
precordial exam, Bilateral
basal crepitations
Kussmaul’s breathing,
Reduced level of
Metabolic Hx of DM, Hx of Renal diseases
Consciousness, Pallor
(anemia)

3- Some signs are specific to certain diseases (clubbing and suppurative lung
diseases, lung cancer, or interstitial lung disease) and should also help
direct investigations to reach a diagnosis
4- CBC and Chest X-ray should be done for all cases
5- Psychological causes are always diagnosed by exclusion of other causes.
6- Treatment is according to the diagnosis

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