approach to dyspnea

1. Approach to
Dyspnea
Dr.Bilal Natiq Nuaman,MD
C.A.B.M. , F.I.B.M.S. , D.I.M. , M.B.Ch.B.
Lecturer in Iraqia Medical College
2018-2019

2. Dyspnea; Breathlessness; Shortness of
Breath (SOB)
• ‘’Dyspnea’’
Dys: difficult, painful
Pneumea:breath
Breathlessness or dyspnea can be defined as the feeling of
an uncomfortable need to breathe.

3. DEFINITION OF DYSPNEA
• Clinical : Asubjective experience of breathing discomfort that
consists of (qualitatively) distinct sensations that vary in
intensity.
• Physiological: The stimulation of pulmonary and extra
pulmonary afferent receptors and the transmission of afferent
information to the cerebral cortex, where the sensation is
perceived as uncomfortable or unpleasant

5. Types of Dyspnea

6. Stages of dyspnea (Exertional-to-Rest)
1--EXERTIONAL DYSPNEA- DYSPNEA DUE
TO EXERCISE

7. 2-PND - PAROXYSMAL NOCTURNAL DYSPNEA
Due to

8. 3-ORTHOPNEA – SOB LYING FLAT AND BETTER
SITTING UP (CHF, pregnancy, resp.muscle
weakness)

9. 4-RESTING DYSPNEA- DYSPNEA AT REST

13. Common Cardiac Causes
• Acute coronary syndromes
• CHF
• Dysrhythmias
• Valvular heart disease
(Congestive heart failure)

14. Common Pulmonary Causes
• Obstructive lung disease
• Asthma/COPD (Chronic Bronchitis ,Emphysema)
• Pneumonia
• Pulmonary embolism
• Pneumothorax

15. Common Miscellaneous Causes
• Metabolic acidosis
• Severe anemia
• Pregnancy
• Hyperthyroidsm
• Hyperventilation syndrome

16. Differential diagnosis of dyspnea
Patients with breathlessness present either with
Chronic exertional dyspnea
Or
Acute dyspnea,
when symptoms are prominent even at rest.

20. • Chronic: Dyspnea >30 days
that develops over weeks, months or years.
• COPD
• Left ventricular failure
• Lung fibrosis
• Asthma (uncontrolled)
• Pleural effusion

31. Pulmonary oedema is suggested by pink, frothy sputum and
bi-basal crackles.
asthma or COPD by wheeze and prolonged expiration.
pneumothorax by a silent resonant hemithorax; and
pulmonary embolus by severe breathlessness with normal
breath sounds.
Leg swelling may suggest cardiac failure or, if asymmetrical,
venous thrombosis causing pulmonary embolism.

32. Physical signs in dyspnic patient

33. Investigations
Chest radiograph (CXR): weather cardiac or pulmonary
Cardiac Causes! Pulmonary causes!
ECG Pulmonary function test
(abnormally significant) (abnormally significant)
Echo CT scan of chest
(abnormally significant) ( abnormally significant)
Coronary angiography Lung Biopsy

34. CXR