This document presents 6 case studies of patients presenting with dyspnoea or shortness of breath. Case 1 describes a 72-year-old woman admitted to the hospital with fever and progressive shortness of breath with a history of rheumatoid arthritis. Case 2 involves a 45-year-old heavy smoker with increasing dyspnea, cough, and finger clubbing. Case 3 is about a 76-year-old man with exertional dyspnea and multiple conditions including myasthenia gravis. Case 4 presents a 48-year-old male with fever, cough, weight loss, and right-sided chest pain and shortness of breath. Case 5 describes a 66-year-old woman with increasing shortness

1. Professor Md.Toufiqur Rahman
MBBS, FCPS, MD, FACC, FESC, FRCP, FSCAI,
FCCP,FAPSC, FAPSIC, FAHA,FACP,FASE
Professor and Head of Cardiology
Colonel Malek Medical College , Manikganj
.
drtoufiq19711@yahoo.com
DYSPNOEADYSPNOEA
(Case based)(Case based)

2. Case 1
• A 72 year old woman was admitted to hospital
because of a few days history of progressive
shortness of breath. She had associated fever but
no cough or sputum production. Her medical
history included rheumatoid arthritis, for which she
had been taking methotrexate for the past 12 years.

3. Case 2
• A 45-year-old heavy smoker presented with
increasing dyspnea and persistent cough. He had been
working as craftsman for 35 years with a history of
exposure to cement dust, but not to birds or other
animals, fungi or other organic fine particles. He did
not report weight loss, sweat or fever. On examination
he had normal vital signs and was comfortable at rest.
Extremities showed considerable clubbing of fingers
and toes. Chest examination revealed fine inspiratory
basal crackles. Chest radiograph showed
reticulonodular infiltrates in both lung bases. HRCT
showed diffuse ground glass opacities predominantly
involving the lung bases, and subpleural fibrosis .
Pulmonary function test (PFT) showed: a moderate
restriction and a moderate to severe diffusion
abnormality.

4. Case 3
• A 76-year-old man presented with severe exertional
dyspnoea. He suffered from mild chronic obstructive
pulmonary disease, congestive cardiac failure and
seropositive myasthaenia gravis. Clinical examination
of his chest and heart were unremarkable but he had
speech dyspnoea and was unable to count to 20 in a
single breath. Consecutive sniff nasal inspiratory
measurements (SNIP) fell from 55 to 33 cm H 2O and
forced vital capacity (FVC) fell from 3.4 to 2.4 L. A
diagnosis of myasthenic crisis was carried out and
treatment with non-invasive ventilation, intravenous
immunoglobulis and high-dose oral prednisolone was
initiated. The patient responded well .

5. Case 4
• A 48-year-old, male patient presented during the day
for an urgent consultation. For over 10 weeks, he had
had a history of high-grade fever (39°C), cough with
mucopurulent expectoration, shortness of breath,
right-sided chest pain, weight loss (>10%) and night
sweats. General examination showed a thin body build,
pale skin and extreme dyspnoea with oxygen
saturation of 77%. An examination of the chest
revealed air and fluid in the pleural space on the right
side of the body. All other systems were checked and
were all clinically normal. A posteroanterior chest
radiography was performed and showed an air–fluid
level in the right hemithorax and a minimal shift of
mediastinum towards the left .

6. Case 5
• A 66 year old female presented to an outside hospital
with increasing shortness of breath and cough. She
complained of a non-productive cough for
approximately six weeks. She denied hemoptysis but
complained of a low grade fever. Over this time she
became progressively more short of breath. At the
time of presentation she was able to only walk one
hundred meters before she had to stop due to
dyspnea.Her past medical history included obesity,
gastroesophageal reflux disease (GERD), peripheral
vascular disease, hypertension, and type II diabetes.
Lateral view on chest x-ray demonstrating left upper
lobe consolidation. Computed tomography image of
the chest demonstrating left upper lobe (LUL)
consolidation with endobronchial lesion in LUL
bronchus.

7. Case 6
• Mr. X 68 yrs old pleasant gentleman admitted in CCU of UHL
for respiratory distress along with sweating for 2 hours. He
had also history of exertional dyspnoea and dyspepsia for last
4 days. He is diabetic, hypertensive and nonalcoholic. On G/E
his Pulse-104/min, BP-120/ 90mmHg, RR-20/min and cardiac
examination showed thatthere was a pansystolic murmur
over the tricuspid area which increased with accentuated
pulmonary component of the second heart sound.
Electrocardiography showed sinus tachycardia with SIQ3T3.
Chest X-Ray revealed cardiomegaly. 2-D transthoracic
echocardiography showed a dilated right side of the heart
with a 5.7 cm × 1.4 cm mass in the right pulmonary artery. CT
pulmonary angiography found pulmonary embolism involving
the right pulmonary artery and most of their segmental
branches. He underwent a duplex scan of the deep venous
system of both lower limbs, which was found to be deep
venous thrombosis in left popliteal vein.

45. Assessment of dyspnoea

67. Thank you all