Differential diagnosis of chronic dyspnea, as titled.

1. Differential Diagnosis of
Chronic Dyspnea
Presented by

2. Differential Diagnosis
Dyspnea
Pivotal Finding
Treatment
Obvious diagnosis
MI, Pneumothorax, profound anemia
Symptom to Diagnosis: An Evidence-Based Guide, 3rd

3. Differential Diagnosis
Pivotal Finding
Pneumonia
Asthma (w/ infection)
COPD (w/ infection)
Pulmonary emboli
Endocarditis
ILD
ARDS
Pneumonia
Asthma
COPD
Pulmonary emboli
Pneumothorax
Exudative pleural
effusion
Acute
Heart failure
Pneumonia
Asthma
COPD
Pulmonary emboli
Fever Pleuritic chest pain Other chest pain None
Chronic
Symptom to Diagnosis: An Evidence-Based Guide, 3rd

4. Acute & Chronic Dyspnea
Nonpleuritic Chest Pain
Pleuritic Chest Pain Acute Chronic
Pneumonia Myocardial infarction Angina (CAD)
Pulmonary emboli Aortic dissection
Angina
(aortic stenosis)
Asthma Pulmonary emboli Angina (anemia)
COPD Pneumonia Arrhythmia
Pneumothorax Arrhythmia Asthma
Pleural effusion,
exudative
Pneumothorax COPD
Symptom to Diagnosis: An Evidence-Based Guide, 3rd

5. Chest Pain or not?
Heart failure
Asthma
COPD
Chronic bronchitis
Pulmonary emboli
Angina
Arrhythmia
Asthma
COPD
Pulmonary emboli
Chest Pain
✔ ×

6. Possible Causes
Heart failure
Asthma
COPD
Chronic bronchitis
Pulmonary emboli

7. Differential Diagnosis
Heart failure
Asthma
COPD
Pulmonary
emboli
Minor edema in
lower extremities
CXR
?

8. COPD & Asthma
• The degree of ‘reversibility’
• History taking
• Pulmonary function tests (PFTs)
UpToDate: Diagnosis of asthma in adolescents and adults

9. Pulmonary Function Tests
Mechanism
Key PFT
Abnormality
Other PFT Finding
Obstructions
(all types)
↓ Flows
↓FEV1/FVC
TLC N↑
RV↑
COPD
(chronic bronchitis)
COPD
(emphysema)
DLCO↓
Asthma
Above &
Bronchodilator
produces an
increase of ≥ 12%↑