Overview
Dyspnoea, or shortness of beath, refers to the feeling of 'not getting enough air' or 'air hunger'. Thi may herald cardiorespiratory disease, though may also occur in the context of many other acute and chronic conditions.
Aetiology
Causes of Acute Dyspnoea
Respiratory
- Obstruction - asthma, COPD
- Bronchiectasis - cystic fibrosis, ABPA
- Vascular - pulmonary embolus, pulmonary hypertension
- Interstitial lung disease
- Pneumonia
- Aspiration
- Lung cancer
- Pneumothorax
- Pleural effusion
- Anaphylaxis
- Obesity hypoventilation syndrome
Cardiovascular
- Heart failure
- Pulmonary oedema
- Myocardial ischaemia
- Cardiomyopathy
- Congenital heart disease
- Valvular disease - aortic stenosis, aortic regurgitation
- Tamponade
Other
- Anaemia
- Kyphoscoliosis
- Metabolic acidosis
- Late pregnancy
- Neurologic - Guillain Barre, motor neuron disease
- Muscular dystrophy
- Anxiety
Causes of Chronic Dyspnoea
Other
- 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
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