Sandbox:Mitra

Diseases	Symptoms			Physical Examination			Diagnostic tests				Other Findings
	Dyspnea on Exertion	Chest Pain	Hemoptysis	Fever	Tachypnea	Tachycardia	Chest X-ray	EKG	CT scan and MRI
Pulmonary embolism	On CT angiography: Intra-luminal filling defect On MRI: Narrowing of involved vessel No contrast seen distal to obstruction Polo-mint sign (partial filling defect surrounded by contrast)	S1Q3T3 pattern representing acute right heart strain	Fleischner sign (enlarged pulmonary artery), Hampton hump, Westermark's sign	✔	✔	✔ (Low grade)	✔	✔ (In case of massive PE)	✔	-	-	-	-	Hypercoagulating conditions (Factor V Leiden, thrombophilia, deep vein thrombosis, immobilization, malignancy, pregnancy)	May be associated with metabolic alkalosis and syncope
Congestive heart failure	On CT scan: Mediastinal lymphadenopathy Hazy mediastinal fat On MRI: Abnormality of cardiac chambers (hypertrophy, dilation) Delayed enhancement MRI may help characterize the myocardial tissue (fibrosis) Late enhancement of contrast in conditions such as myocarditis, sarcoidosis, amyloidosis, Anderson-Fabry's disease, Chagas disease)	Goldberg's criteria may aid in diagnosis of left ventricular dysfunction: (High specificity) SV1 or SV2 + RV5 or RV6 ≥3.5 mV Total QRS amplitude in each of the limb leads ≤0.8 mV R/S ratio <1 in lead V4	Cardiomegaly	✔	✔	✔	-	-	✔	-	-	-	-	Previous myocardial infarction Hypertension (systemic and pulmonary) Cardiac arrythmias Viral infections (myocarditis) Congenital heart defects	Right heart failure associated with: Hepatomegaly Positive hepato-jugular reflex Increased jugular venous pressure Peripheral edema Left heart failure associated with: Pulmonary edema Eventual right heart failure
Percarditis	On contrast enhanced CT scan: Enhancement of the pericardium (due to inflammation) Pericardial effusion Pericardial calcification On gadolinium-enhanced fat-saturated T1-weighted MRI: Pericardial enhancement (due to inflammation) Pericardial effusion	ST elevation PR depression	Large collection of fluid inside the pericardial sac (pericardial effusion) Calcification of pericardial sac	✔	✔	✔ (Low grade)	✔ (Relieved by sitting up and leaning forward)	-	✔	-	-	-	-	Infections: Viral (Coxsackie virus, Herpes virus, Mumps virus, HIV) Bacteria (Mycobacterium tuberculosis-common in developing countries) Fungal (Histoplasmosis) Idiopathic in a large number of cases Autoimmune Uremia Malignancy Previous myocardial infarction	May be clinically classified into: Acute (< 6 weeks) Sub-acute (6 weeks - 6 months) Chronic (> 6 months)
Pneumonia	On CT scan: (not generally indicated) Consolidation (alveolar/lobar pneumonia) Peribronchial nodules (bronchopneumonia) Ground-glass opacity (GGO) Abscess Pleural effusion On MRI: Not indicated	Prolonged PR interval Transient T wave inversions	Consolidation (alveolar/lobar pneumonia) Peribronchial nodules (bronchopneumonia) Ground-glass opacity (GGO)	✔	✔	✔	✔	-	✔	✔	-	-	-	Ill-contact Travelling Smoking Diabetic Recent hospitalization Chronic obstructive pulmonary disease	Requires sputum stain and culture for diagnosis Empiric management usually started before culture results
Vasculitis	On CT scan: (Takayasu arteritis) Vessel wall thickening Luminal narrowing of pulmonary artery Masses or nodules (ANCA-associated granulomatous vasculitis) On MRI: Homogeneous, circumferential vessel wall swelling	Right or left bundle-branch block (Churg-Strauss syndrome) Atrial fibrillation (Churg-Strauss syndrome) Non-specific ST segment and T wave changes	Nodules Cavitation	✔	✔	✔	✔	✔	✔	-	✔	✔	✔	Takayasu arteritis usually found in persons aged 4-60 years with a mean of 30 Giant-cell arteritis usually occurrs in persons aged > 60 years Churg-Strauss syndrome may present with asthma, sinusitis, transient pulmonary infiltrates and neuropathy alongwith cardiac involvement Granulomatous vasculitides may present with nephritis and upper airway (nasopharyngeal) destruction
Chronic obstructive pulmonary disease (COPD)	On CT scan: Chronic bronchitis may show bronchial wall thickening, scarring with bronchovascular irregularity, fibrosis Emphysema may show alveolar septal destruction and airspace enlargement (Centrilobular- upper lobe, panlobular- lower lobe) Giant bubbles On MRI: Increased diameter of pulmonary arteries Peripheral pulmonary vasculature attentuation Loss of retrosternal airspace due to right ventricular enlargement Hyperpolarized Helium MRI may show progressively poor ventilation and destruction of lung	Multifocal atrial tachycardia (atleast 3 distinct P wave morphologies)	Enlarged lung shadows (emphysema) Flattening of diaphragm (emphysema)	✔	✔	-	-	-	✔	✔	-	-	-	Smoking Alpha-1 antitrypsin deficiency Increased sputum production (chronic bronchitis) Cough	Alpha 1 antitrypsin deficiency may be associated with hepatomegaly
COVID-19-associated heart failure

Other Conditions that Cause Dyspnea that are Emergencies

The following emergency conditions should be excluded when diagnosing a patient with heart failure:

• Asthma or bronchospasm
• Foreign body aspiration
• H. influenza epiglottitis
• Spontaneous pneumothorax

Non Cardiac Causes of Dyspnea

• Abdominal masses
• Acute bronchitis
• Acute Chest Syndrome
• Acute myeloid leukemia
• Acute promyelocytic leukemia
• Acute tracheobronchitis
• AIDS
• Air pollution
• Air-conditioner lung
• Allergy
• Alpha 1-antitrypsin deficiency
• Altitude sickness
• Amniotic fluid embolism
• Amphotericin B
• Amyl nitrite
• Amyotrophic Lateral Sclerosis (ALS)
• Anaphylactoid reactions
• Anaphylaxis
• Anemia
• Anthrax
• Anxiety
• Asbestosis
• Aspergillus clavatus
• Aspiration
• Asthma
• Atelectasis
• Atypical pneumonia
• Barium
• Beta-blockers
• Betazole
• Bird breeder's lung
• Bird fancier's lung
• Bland-White-Garland Syndrome
• Bleomycin in ABVD
• Blood transfusion
• Brain stem infarction
• Bronchial asthma
• Bronchial tumors
• Bronchiolitis
• Bronchiolitis obliterans
• Bronchiolitis obliterans organizing pneumonia
• Bronchitis
• Bronchogenic carcinoma
• Bronchoscopy
• Cardiovascular syphilis
• Caspofungin
• Cheese worker's lung
• Chemical worker's lung
• Chest trauma
• Chest tube
• Cholesterol pericarditis
• Chronic bronchitis
• Chronic fatigue syndrome
• Chronic Obstructive Pulmonary Disease (COPD)
• Chylothorax
• Cirrhosis
• Cladosporium
• CMV Pneumonitis
• Community-acquired pneumonia
• Croup
• Cystic Fibrosis
• Daptomycin
• Decompression sickness
• Decreased thoracic or diaphragmatic excursion
• Diabetic coma
• Diffuse panbronchiolitis
• Diverticulosis
• Drugs
• Ehrlichiosis (canine)
• Empty nose syndrome
• Empyema, pleural
• Encephalitis
• Eosinophilic pneumonia
• Ephedrine
• Epidemic dropsy
• Erdheim-Chester disease
• Esophageal cancer
• Esophageal diseases with tracheal compression
• Exercise-induced asthma
• Extrinsic allergic alveolitis
• Fat embolism
• Fibrosing alveolitis, cryptogenic
• Gamma-Hydroxybutyric acid
• Gastroesophageal reflux
• Gemeprost
• Glatiramer acetate
• Glottal edema
• Goiter
• Goodpasture syndrome
• Grain handler's lung
• Gram-negative sepsis
• Guillain-Barre Syndrome
• Hemochlyothorax
• Hemothorax
• Histiocytosis X
• Hoose (disease)
• Humidifier lung
• Hydrochlyothorax
• Hypersensitivity Pneumonitis
• Hyperthyroidism
• Hypoxia
• Hysteria
• Idiopathic pulmonary fibrosis
• Iloprost
• Interstitial lung disease
• Intoxication (carbon monoxide, cyanide)
• Intrapulmonary receptor stimulation
• Intussusception (medical disorder)
• Iron deficiency anemia
• Irregular Heart Rhythms
• Ketorolac
• Kyphoscoliosis
• Laryngeal/bronchospasm
• Leukemia
• Lung cancer
• Lymphangitic metastases
• Lymphocytic interstitial pneumonia
• Lymphoma
• Malignant Mesothelioma
• Malt worker's lung
• Mediastinal tumors
• Megaloblastic Anemias
• Mercury (element)
• Metabolic acidosis
• Methyl isocyanate
• Micropolyspora faeni
• Miliary tuberculosis
• Mollusk shell hypersensitivity
• Mucor stolonifer
• Multiple rib fractures
• Myasthenia Gravis
• Myxoma
• Neuromuscular disease
• Obesity
• Phrenic nerve paralysis
• Pleural callosity
• Pneumoconiosis
• Pneumonia
• Pneumochlyothorax
• Pneumothorax
• Pleural Effusion
• Pleural fibrosis
• Polyradiculitis
• Pulmonary arteriovenous malformation
• Pulmonary Emphysema
• Pulmonary fibrosis
• Quincke's Edema
• Radiation pneumonitis
• Respiratory tract infection
• Sarcoidosis
• Shock
• Shock lung
• Sleep Apnea Syndrome
• Trauma
• Tracheal stenosis
• Tracheal tumors
• Tracheomalacia
• Tracheobronchial collapse
• Uremia