Dyspnoea | Cardio History - MedSchool
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Cardio History
 
 
Cardio History
Dyspnoea, or shortness of breath, refers to the feeling of ‘not getting enough air' or ‘air hunger'. This may herald cardiorespiratory disease, or may occur in the context of many other conditions.
 

Dyspnoea

 
 

Overview

  • Dyspnoea, or shortness of breath, refers to the feeling of ‘not getting enough air' or ‘air hunger'. This may herald cardiorespiratory disease, or may occur in the context of many other conditions.

Aetiology

  •  Acute
    Chronic
    Resp

    Asthma

    COPD exacerbation

    Pneumonia

    Aspiration

    Pulmonary embolus

    Pneumothorax

    Anaphylaxis

    Asthma

    COPD

    Interstitial fibrosis

    Pleural effusion

    Bronchiectasis

    Cystic fibrosis

    Chronic infection

    Chronic PE

    Lung cancer

    Obesity

    Cardio

    Pulmonary oedema

    Myocardial ischaemia

    Arrhythmia

    Valvular disease

    Tamponade

    Heart failure

    Arrhythmia

    Valvular disease

    Cardiomyopathy

    Pericardial effusion

    Congenital disease

    Other

    Anxiety

    Metabolic acidosis

    Anaemia

    Late pregnancy

    Kyphoscoliosis

    Muscular dystrophy

    ALS

History of Presenting Complaint

    • Onset

      Whether the shortness of breath came on suddenly or gradually; during the day or at night; on exertion; or whether the patient  wakes up short of breath.
    • Sudden onsetSuggestive of severe cause e.g. PE, MI, pneumothorax, anaphylaxis, aspiration, APO, tamponade
    • Paroxysmal nocturnal dyspnoea - suddenly waking with shortness of breathSuggestive of heart failure
    • Onset after surgeryMay be due to PE, ACS or APO
    • Onset post traumaMay represent pneumothorax or rib fracture
    • Timing

    • How long the shortness of breath has been going on for, and whether it is intermittent or constant.
    • Associated Symptoms

      Whether the shortness of breath is associated with any other symptoms.
    • Central chest painSuggestive of pneumonia, pneumothorax, MI or PE
    • Pleuritic chest painSuggestive of pneumonia, pleural effusion or PE
    • PalpitationsMay suggest arrhythmia or anxiety
    • CoughSuggestive of pneumonia, COPD, interstitial fibrosis or bronchiectasis
    • HaemoptysisMay be due to PE, lung cancer or tuberculosis
    • FeversSuggestive of pneumonia
    • WheezeSuggestive of asthma, COPD or pulmonary oedema
    • Leg pain and swellingThink about DVT and risk of PE
    • Exacerbating Factors

      Whether the shortness of breath is worse on exertion, on lying flat, or after exposure to dust.
    • Exertional dyspnoeaMay represent heart failure, interstitial fibrosis or COPD
    • Orthopnoea - shortness of breath when lying flatCharacteristic of congestive cardiac failure
    • Alleviating Factors

      Whether the shortness of breath is relieved with rest, GTN, or with puffers.
    • Relief with bronchodilatorPotential exacerbation of asthma or COPD
    • Exercise Tolerance

    • How far / how many steps they can walk before short of breath, whether this has changed
Last updated on November 11th, 2017
 
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