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

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

• Acute coronary syndromes
• Anaphylaxis
• Asthma
• carbon monoxide poisoning

• cardiac tamponade
• COPD exacerbation
• Pulmonary embolism
• Spontaneous pneumothorax

Common Causes

• Anemia
• Foreign body aspiration
• Heart failure
• Pneumonia
• Pregnancy
• Pulmonary edema

Causes by Organ System

Cardiovascular	Acute coronary syndromes, acute myocardial ischemia, 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, cardiac tamponade, cardiogenic shock, cardiomegaly, cardiomyopathy, central sleep apnea, cholesterol pericarditis, complete heart block, congenital heart disease, congestive heart failure, continuous murmur, cor Pulmonale, coronary artery disease, coronary artery fistula, diseases of the pericardium, constrictive pericarditis, cor triatriatum, dysrhythmia, Ebstein's anomaly of the tricuspid valve, eisenmenger syndrome, endocarditis, endomyocardial fibrosis, heart attack, heart failure, hypotension, hypertensive heart disease, hypertrophic cardiomyopathy, hypovolemic shock,inappropriate sinus tachycardia, irregular heart rhythms, ischaemic heart disease, levo-transposition of the great arteries, loeffler's endocarditis, malignant hypertension, micturition syncope, mitral regurgitation, mitral stenosis, morbid obesity, myocardial infarction, myocardial ischaemia, myocarditis, STEMI, patent ductus arteriosus, pericardial effusion, pericardial constriction, pericarditis, perimyocarditis, pneumomediastinum, postprandial hypotension, pulmonary arteriovenous malformation, pulmonary edema, pulmonary embolism, pulmonary hypertension, pulmonary stenosis, right ventricular failure, shock, shock lung, Sick sinus syndrome, sipuleucel-T, tetralogy of Fallot, transposition of the great arteries, tricuspid stenosis, tumors of the myocardium, tuberculin, valvular heart disease, vasovagal syncope, ventricular septal defect
Chemical / poisoning	Alcohol,intoxication, carbon monoxide, chlorine gas), cyanide,
Dermatologic	Facial burns, severe burns
Drug Side Effect	Acetaminophen and oxycodone, acetylcysteine, agalsidase beta, aldesleukin, amphotericin B, amyl nitrite, aztreonam, basiliximab, beta-blockers, betazole, bleomycin , bromocriptine, butorphanol, calcium channel blockers, carfilzomib, caspofungin, cefoxitin sodium, cladosporium, clomifene, crizotinib, cromolyn, cefaclor, cetuximab, corticorelin, cytomegalovirus immune globulin, daptomycin, caspofungin acetate, denileukin diftitox, desmopressin, dexpanthenol, disulfiram, diuretics, drugs, dornase Alfa, efavirenz, enzalutamide, ephedrine, estramustine, febuxostat, felbamate, ferric carboxymaltose,fosaprepitant, fulvestrant, gemcitabine, gemeprost, glatiramer acetate, glutaraldehyde, goserelin, hydroxocobalamin, Ibrutinib, Idelalisib, Iloprost,imipenem-cilastatin, ioxilan,ketorolac, leflunomide, lenalidomide, letrozole, levosimendan, levothyroxine, megestrol, mercury, meropenem, mesalamine, methyl isocyanate, mifepristone, minocycline hydrochloride, moxifloxacin ophthalmic, nabumetone, naltrexone, niacin, nitrofurantoin, oprelvekin, Oxaprozin, Oxcarbazepine, panitumumab, polidocanol, polyethylene glycol-electrolyte solution (PEG-ES), protamine sulfate, pralatrexate, ramucirumab, rimabotulinumtoxinb, rizatriptan, ropinirole, romidepsin, sertraline, sodium nitroprusside, sorafenib, sunitinib, teniposide, thalidomide, thallous Chloride Tl 201, tiagabine, ticagrelor, tocilizumab, topiramate, tretinoin, zonisamide,zoledronate
Ear Nose Throat	Empty nose syndrome, glottic edema, sleep apnea syndrome, retropharyngeal abscess
Endocrine	Diabetic coma, diabetic ketoacidosis, fatigue, goiter, hyperthyroidism, hypothyroidism, morbid obesity, myxedema, myxoma
Environmental	No underlying causes
Gastroenterologic	Abdominal masses, ascites, cirrhosis, diarrhea, diverticulosis, esophageal cancer, esophageal diseases, gastroesophageal reflux, hiatal hernia, intussusception, jaundice, morbid obesity, vomiting
Genetic	Macleod syndrome, sickle cell anemia
Hematologic	Acute myeloid leukemia, acute promyelocytic leukemia, anemia, blood donation, blood transfusion, Erdheim-Chester disease, fat embolism, fatigue, granulocyte-macrophage colony stimulating factor, hemorrhage, histiocytosis X, iron deficiency anemia, leukemia, leukostasis, lymphoma, lymphangiomyomatosis, Macleod syndrome, megaloblastic anemia, Rh problems, sickle cell anemia
Iatrogenic	Barium, bronchoscopy, chest tube, empty nose syndrome, radiation pneumonitis
Infectious Disease	Acute bronchitis, AIDS, anthrax, ascariasis, aspergillus clavatus, atypical pneumonia, bulbar poliomyelitis, CMV pneumonitis, community-acquired pneumonia, croup, diarrhea, ehrlichiosis , leukostasis, sepsis, micropolyspora faeni, miliary tuberculosis, tropical pulmonary eosinophilia, pleural empyema, pneumonia, respiratory tract infection, retropharyngeal abscess, sepsis, tonsillar abscess, toxocariasis
Musculoskeletal / Ortho	Kyphoscoliosis, polyradiculitis
Neurologic	Amyotrophic lateral sclerosis (ALS), brain stem infarction, CNS disease, Duchenne muscular dystrophy, Eaton-Lambert syndrome, encephalitis, fat embolism, fatigue, focal cerebral ischemia, Guillain-Barre Syndrome, micturition syncope, multiple sclerosis, myasthenia gravis, neuromuscular disease, Parkinson's disease, Parsonage-Turner syndrome, phrenic nerve paralysis, post-tussive syncope, seizures, Shy-Drager syndrome
Nutritional / Metabolic	Acidosis, dehydration, morbid obesity, poor diet
Obstetric/Gynecologic	Amniotic fluid embolism, cardiac disease in pregnancy, pregnancy, vomiting
Oncologic	Acute myeloid leukemia, acute promyelocytic leukemia, bronchial tumors, bronchogenic carcinoma, leukemia, lung cancer, lymphangitic metastases, lymphoma, lymphangiomyomatosis, malignant mesothelioma, mediastinal tumors, tracheal tumors, tumors of the myocardium
Opthalmologic	No underlying causes
Overdose / Toxicity	Snake bite, narcotics over dose, toxins
Psychiatric	Anxiety disorders, depression, emotional stress, fatigue, fear, generalized anxiety disorder, hysteria, panic attacks
Pulmonary	Acute bronchitis , acute chest syndrome, acute lung syndrome, acute tracheobronchitis, adult respiratory distress syndrome, air-conditioner lung, alpha 1-antitrypsin deficiency, asbestosis, aspiration, asthma, atelectasis, bird breeder's lung, bird fancier's lung, bronchial asthma, bronchial atresia, bronchial tumors, bronchiectasis, bronchiolitis, bronchiolitis obliterans, bronchiolitis obliterans organizing pneumonia, bronchitis, bronchogenic carcinoma, bronchogenic cyst, bronchopulmonary dysplasia, central sleep apnea, cheese worker's lung, chemical worker's lung, chest trauma, chronic bronchitis, chronic obstructive pulmonary disease (COPD), chylothorax, CMV pneumonitis, community-acquired pneumonia, churg - Strauss Syndrome, coal worker pneumoconiosis, cor pulmonale, cystic fibrosis, cystic adenomatoid malformation of lung, decreased thoracic or diaphragmatic excursion, diffuse panbronchiolitis, pleural empyema, emphysema, eosinophilic pneumonia, epiglottitis,exercise-induced asthma, extrinsic allergic alveolitis, fat embolism, fibrosing alveolitis, cryptogenic, flail chest, flash pulmonary edema Goodpasture syndrome, grain handler's lung, hemochlyothorax, hemothorax, histiocytosis X, humidifier lung, hydrochlyothorax, hypersensitivity pneumonitis, hypoxia, idiopathic pulmonary fibrosis, interstitial lung disease, bronchospasm, larynx fracture, lung cancer, lymphocytic interstitial pneumonia, malt worker's lung, miliary tuberculosis, pleural callosity, pleural effusion, pleural fibrosis, pleurisy,pneumoconiosis, pneumochlyothorax, pneumonia, pneumothorax, pneumomediastinum, pulmonary alveolar proteinosis, pulmonary arteriovenous malformation, pulmonary edema, pulmonary embolism, pulmonary emphysema, pulmonary fibrosis, pulmonary hypertension, respiratory failure, respiratory distress syndrome (neonatal), sclerosing mediastinitis, sequestered lung, shock lung, smoke inhalation, smoking, Stiff lungs, stridor, tension pneumothorax, tonsillar abscess, tracheal stenosis, tracheal tumors, tracheomalacia, tracheolaryngobronchitis,tracheobronchial collapse, transient tachypnea of the newborn, tropical pulmonary eosinophilia
Renal / Electrolyte	Acidosis, dehydration, Goodpasture syndrome, metabolic acidosis, uremia
Rheum / Immune / Allergy	Allergy, anaphylactoid reactions, anaphylaxis, asthma, bronchial asthma, churg - Strauss Syndrome, Duchenne muscular dystrophy,granulocyte-macrophage colony stimulating factor, hypersensitivity pneumonitis, lymphocytic interstitial pneumonia, mollusk shell hypersensitivity, mucor stolonifer, polyarteritis nodosa, quincke's edema, systemic sclerosis
Sexual	No underlying causes
Trauma	Rib fractures, chest trauma, trauma
Urologic	Micturition syncope
Miscellaneous	Air pollution, altitude sickness, choking, chronic fatigue syndrome, decompression sickness, deconditioning, epidemic dropsy, gamma-hydroxybutyric acid, Ludwig's angina, 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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