Summary
Dyspnea, also known as shortness of breath or breathlessness, is a subjective sensation of breathing discomfort.
Activation of several pathways can lead to the sensation of breathlessness. Increased work of breathing, stimulation of the receptors of the upper or lower airway, lung parenchyma, or chest wall, and excessive stimulation of the respiratory center by central and peripheral chemoreceptors can all lead to this sensation. These stimuli are transferred to the central nervous system via respiratory muscle and vagal afferents and are then processed in the context of the affective state, attention, and prior experience of the patient, resulting in dyspnea. [1] [2]
The evaluation and management of dyspnea is directed by the clinical presentation, findings from the history and physical exam, and preliminary investigation results.
The etiology of dyspnea covers a broad range of pathologies from mild, self-limited processes to life-threatening conditions. Diseases of the cardiovascular, pulmonary, and neuromuscular systems are the most common etiologies.
Differential diagnosis
- Common
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- COPD
- Pulmonary tumors
- Infective pneumonitis (bacterial, viral, fungal, tuberculous)
- Noninfective pneumonitis (eosinophilic, radiation, aspiration, hypersensitivity pneumonitis)
- Bronchiectasis
- Interstitial lung disease
- Sarcoidosis
- Asthma
- Bronchitis
- Laryngitis
- Epiglottitis
- Obstructive sleep apnea
- Pulmonary embolism (thrombotic, air, amniotic fluid, tumor)
- Pleural effusion and pleural tumors
- Acute coronary syndrome and angina
- Congestive heart failure
- Anemia
- Methemoglobinemia and carbon monoxide poisoning
- Thrombotic thrombocytopenic purpura
- Gastroesophageal reflux disease
- Ascites
- Stroke
- Shock
- Thyroid disease
- Anxiety and panic attacks
- Normal aging, deconditioning, and obesity
- Uncommon
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- Pulmonary contusion
- Angioedema
- Foreign body aspiration
- Tracheobronchial tumors (benign or malignant)
- Retrosternal goiter
- Vocal cord dysfunction
- Pulmonary hypertension
- Hepatopulmonary syndrome
- Pulmonary arteriovenous malformations
- Mesothelioma
- Pneumothorax and pneumomediastinum
- Pleuritis
- Hemothorax
- Arrhythmias
- Acquired valvular heart disease
- Congenital heart disease
- Cardiac drugs
- Myocardial disease (cardiomyopathy, myocarditis)
- Pericardial disease
- Aortic dissection
- Superior vena cava syndrome
- Pulmonary leukostasis
- Tetanus
- Botulism
- Amyotrophic lateral sclerosis
- Polio and other acute viral anterior horn infections
- Guillain-Barre syndrome
- Myasthenia gravis
- Respiratory muscle deficiency
- Paraneoplastic myasthenic syndrome
- Anaphylaxis
- Cushing syndrome
- Pheochromocytoma
- Kyphoscoliosis and pectus excavatum
- Diphtheria
