Dyspnea causes

Dyspnea Microchapters
Patient Information
Overview
Pathophysiology
Causes
Differentiating Dyspnea from other Diseases

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Kiran Singh, M.D. [2]

Overview

The four general categories of dyspnea are based on its causes: cardiac, pulmonary, mixed cardiac or pulmonary, and noncardiac or nonpulmonary. Sudden onset of dyspnea (acute dyspnea) is most typically associated with narrowing of the airways or airflow obstruction (bronchospasm), blockage of one of the arteries of the lung (pulmonary embolism), acute heart failure or myocardial infarction, pneumonia, or panic disorder. Long-standing dyspnea (chronic dyspnea) is most often a manifestation of chronic or progressive diseases of the lung and / or heart, such as COPD, which includes chronic bronchitis and emphysema.

Dyspnea also is experienced by individuals encountering high-altitude sickness (high-altitude pulmonary edema, [HAPE]). This is associated with rapid rate of mountain ascent and normally occurs during the first 1 to 3 days of achieving a high altitude. Dyspnea resolves with use of supplemental oxygen, rapid descent, and occasionally hyperbaric therapy.

Causes

Life Threatening Causes

• Acute myocardial infarction
• Acute Heart Failure
• Asthma
• COPD exacerbation

Common Causes

• Acute heart failure
• Acute papillary muscle rupture
• Cardiac tamponade
• Foreign body aspiration
• Spontaneous pneumothorax
• H. influenza epiglottitis
• Bronchospasm
• Pulmonary edema

Causes by Organ System

Cardiovascular	Acute coronary syndromes, angina pectoris, aortic arch anomalies, aortic dissection, aortic regurgitation, aortic stenosis, arrhythmia, atrial fibrillation, atrioseptal defect, beriberi heart disease, biventricular heart failure, bicalutamide, Bland-White-Garland Syndrome, cardiac disease in pregnancy, cardiac failure, cardiomegaly, cardiomyopathy, cholesterol pericarditis, congenital heart disease, congestive heart failure, continuous murmur, cor Pulmonale, coronary artery disease, coronary artery fistula, diseases of the pericardium cardiac tamponade, constrictive pericarditis pericardial effusion, Ebstein's anomaly of the tricuspid valve, endocarditis, endomyocardial fibrosis, heart failure, hypertension, hypertensive heart disease, hypertrophic cardiomyopathy, inappropriate sinus tachycardia, irregular heart rhythms, ischaemic heart disease, levo-transposition of the great arteries, loeffler's Endocarditis, malignant hypertension, mitral regurgitation, mitral stenosis, myocardial infarction, STEMI, patent ductus arteriosus, pericardial effusion, pericardial constriction, perimyocarditis, pulmonary arteriovenous malformation, pulmonary edema, pulmonary embolism, pulmonary hypertension, pulmonary stenosis, right ventricular failure, shock, shock lung, sipuleucel-T, tetralogy of Fallot, tricuspid stenosis, tumors of the myocardium, tuberculin, valvular heart disease, ventricular septal defect
Chemical / poisoning	Intoxication (carbon monoxide, cyanide)
Dermatologic	No underlying causes
Drug Side Effect	Acetaminophen and oxycodone, acetylcysteine, agalsidase beta, aldesleukin, amphotericin B, amyl nitrite, aztreonam, basiliximab, beta-blockers, betazole, bleomycin , bromocriptine, butorphanol, carfilzomib, caspofungin, cefoxitin sodium, cladosporium, clomifene, caspofungin acetate, crizotinib, cromolyn, cefaclor, corticorelin, cytomegalovirus immune globulin, daptomycin, denileukin diftitox, desmopressin, dexpanthenol, disulfiram, drugs, dornase Alfa, efavirenz, enzalutamide, ephedrine, estramustine, febuxostat, felbamate, ferric carboxymaltose,fosaprepitant, fulvestrant, gemcitabine, gemeprost, glatiramer acetate, goserelin, hydroxocobalamin, Ibrutinib, Idelalisib, Iloprost,Imipenem-Cilastatin, Ioxilan,Ketorolac, Leflunomide, Lenalidomide, Letrozole, Levothyroxine, megestrol, mercury, meropenem, mesalamine, methyl isocyanate, mifepristone, minocycline hydrochloride, moxifloxacin ophthalmic, nabumetone, naltrexone, niacin, oprelvekin, Oxaprozin, Oxcarbazepine, panitumumab, polidocanol, polyethylene glycol-electrolyte solution (PEG-ES), protamine sulfate, pralatrexate, ramucirumab, rimabotulinumtoxinb, rizatriptan, ropinirole, romidepsin, sertraline, sorafenib, sunitinib, teniposide, thalidomide, thallous Chloride Tl 201, tiagabine, tocilizumab, topiramate, tretinoin, zonisamide,zoledronate
Ear Nose Throat	Glottic edema, sleep apnea syndrome, empty nose syndrome
Endocrine	Diabetic coma, goiter, hyperthyroidism, hypothyroidism, myxoma
Environmental	No underlying causes
Gastroenterologic	Abdominal masses, cirrhosis, diverticulosis, esophageal cancer, esophageal diseases, gastroesophageal reflux, intussusception
Genetic	No underlying causes
Hematologic	Acute myeloid leukemia, acute promyelocytic leukemia, anemia, blood transfusion, Erdheim-Chester disease, histiocytosis X, iron deficiency anemia, leukemia, lymphoma, megaloblastic anemia
Iatrogenic	Barium, bronchoscopy, chest tube, empty nose syndrome, radiation pneumonitis
Infectious Disease	Acute bronchitis, AIDS, anthrax, aspergillus clavatus, atypical pneumonia, CMV Pneumonitis, community-acquired pneumonia, croup, ehrlichiosis , sepsis, micropolyspora faeni, miliary tuberculosis, pleural empyema, pneumonia, respiratory tract infection, sepsis
Musculoskeletal / Ortho	Kyphoscoliosis, polyradiculitis
Neurologic	Amyotrophic lateral sclerosis (ALS), brain stem infarction, Eaton-Lambert syndrome, encephalitis, Guillain-Barre Syndrome, multiple sclerosis, myasthenia gravis, neuromuscular disease, Parsonage-Turner syndrome, phrenic nerve paralysis
Nutritional / Metabolic	Acidosis
Obstetric/Gynecologic	Amniotic fluid embolism, cardiac disease in pregnancy
Oncologic	Acute myeloid leukemia, acute promyelocytic leukemia, bronchial tumors, bronchogenic carcinoma, leukemia, lung cancer, lymphangitic metastases, lymphoma, malignant mesothelioma, mediastinal tumors, tracheal tumors, tumors of the myocardium
Opthalmologic	No underlying causes
Overdose / Toxicity	No underlying causes
Psychiatric	Anxiety disorders, hysteria, panic attacks
Pulmonary	Acute bronchitis , acute chest syndrome, acute tracheobronchitis, air-conditioner lung, alpha 1-antitrypsin deficiency, asbestosis, aspiration, asthma, atelectasis, bird breeder's lung, bird fancier's lung, bronchial asthma, bronchial tumors, bronchiolitis, bronchiolitis obliterans, bronchiolitis obliterans organizing pneumonia, bronchitis, bronchogenic carcinoma, cheese worker's lung, chemical worker's lung, chest trauma, chronic bronchitis, chronic obstructive pulmonary disease (COPD), chylothorax, CMV Pneumonitis, community-acquired pneumonia, cor pulmonale, cystic fibrosis, decreased thoracic or diaphragmatic excursion, diffuse panbronchiolitis, pleural empyema, eosinophilic pneumonia, exercise-induced asthma, extrinsic allergic alveolitis, fat embolism, fibrosing alveolitis, cryptogenic, Goodpasture syndrome, grain handler's lung, hemochlyothorax, hemothorax, histiocytosis X, humidifier lung, hydrochlyothorax, hypersensitivity pneumonitis, hypoxia, idiopathic pulmonary fibrosis, interstitial lung disease, bronchospasm, lung cancer, lymphocytic interstitial pneumonia, malt worker's lung, miliary tuberculosis, pleural callosity, pneumoconiosis, pneumochlyothorax, pneumonia, pneumothorax, pleural effusion, pleural fibrosis, pulmonary arteriovenous malformation, pulmonary edema, pulmonary embolism, pulmonary emphysema, pulmonary fibrosis, pulmonary hypertension, shock lung, tracheal stenosis, tracheal tumors, tracheomalacia, tracheobronchial collapse
Renal / Electrolyte	Acidosis, goodpasture syndrome, metabolic acidosis, uremia
Rheum / Immune / Allergy	Allergy, anaphylactoid reactions, anaphylaxis, asthma, bronchial asthma, hypersensitivity pneumonitis, lymphocytic interstitial pneumonia, mollusk shell hypersensitivity, mucor stolonifer, quincke's edema
Sexual	No underlying causes
Trauma	Rib fractures, chest trauma, trauma
Urologic	No underlying causes
Miscellaneous	Air pollution, altitude sickness, chronic fatigue syndrome, decompression sickness, epidemic dropsy, gamma-hydroxybutyric acid, obesity, sarcoidosis

Causes in Alphabetical Order

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Causes Based on Pathophysiology

Obstructive Lung Diseases

• Asthma
• Bronchitis
• Chronic obstructive pulmonary disease
• Cystic fibrosis
• Emphysema
• Hookworm disease
• Laryngeal edema due to allergies
• Tuberculosis

Diseases of Lung Parenchyma and Pleura

Contagious

• Anthrax through inhalation of Bacillus anthracis
• Pneumonia

Non-Contagious

• Fibrosing alveolitis
• Atelectasis
• Hypersensitivity pneumonitis
• Interstitial lung disease
• Lung cancer
• Pleural effusion
• Pneumoconiosis
• Pneumothorax
• Non-cardiogenic pulmonary edema or acute respiratory distress syndrome
• Sarcoidosis

Pulmonary Vascular Diseases

• Acute or recurrent pulmonary emboli
• Pulmonary hypertension, primary or secondary
• Pulmonary veno-occlusive disease
• Superior vena cava syndrome

Obstruction of the Airway

• Cancer of the larynx or pharynx
• Empty nose syndrome
• Pulmonary aspiration
• Epiglottitis

Immobilization of the Diaphragm

• Lesion of the phrenic nerve
• Polycystic liver disease
• Tumor in the diaphragm

Restriction of the Chest Volume

• Ankylosing spondylitis
• Broken ribs
• Kyphosis
• Obesity
• Pregnancy
• Pectus excavatum
• Scoliosis

References

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