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__NOTOC__
{{Infobox_Disease |
{{Infobox_Disease |
   Name          = {{PAGENAME}} |
   Name          = {{PAGENAME}} |
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'''Dyspnea on exertion''' ('''DOE''' or '''exertional dyspnea''') indicates dyspnea that occurs (or worsens) during [[Exercise|physical activity]].
'''Dyspnea on exertion''' ('''DOE''' or '''exertional dyspnea''') indicates dyspnea that occurs (or worsens) during [[Exercise|physical activity]].


==Conditions That Dyspnea Should be Distinguished From==
==Differentiating Dyspnea from other Conditions==
* [[Air hunger]] the sensation of an urgent need to breathe, sensation that you cannot take in a full breath
* [[Air hunger]] the sensation of an urgent need to breathe, sensation that you cannot take in a full breath
* [[Tachypnea]] breathing rapidly
* [[Tachypnea]] breathing rapidly
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==Life Threatening Causes of Dyspnea Requiring Urgent Evaluation and Management==
==Life Threatening Causes of Dyspnea Requiring Urgent Evaluation and Management==


==Causes==
===Common Causes===
* [[Acute heart failure]]
* [[Acute heart failure]]
* [[Acute papillary muscle rupture]]
* [[Acute papillary muscle rupture]]
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* [[Pulmonary edema]]
* [[Pulmonary edema]]


===Complete Differential Diagnosis of the Causes of Dyspnea===
===Causes by Organ System
(By organ system)
{|style="width:70%; height:100px" border="1"
{|style="width:70%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
|bgcolor="Beige"| [[Metabolic acidosis]]
|-
|-bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| No underlying causes
|-
|-
|}
|}
|}


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* [[Pectus excavatum]]
* [[Pectus excavatum]]
* [[Scoliosis]]
* [[Scoliosis]]
|-
 
|-bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
|bgcolor="Beige"| [[Metabolic acidosis]]
|-
|-bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|-
|}


==Diagnosic Evaluation==
==Diagnosic Evaluation==

Revision as of 19:56, 31 August 2012

Dyspnea
ICD-10 R06.8
ICD-9 786.0
DiseasesDB 15892
MedlinePlus 003075
MeSH C08.618.326

WikiDoc Resources for Dyspnea

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Experimental / Informatics

List of terms related to Dyspnea

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

Synonyms and Key words: Breathlessness, DIB, difficulty breathing, dyspnoea, respiration difficult, respiratory distress, shortness of breath, SOB.

Overview

Dyspnea or dyspnoea (pronounced disp-nee-ah, IPA /dɪsp'niə/), from Latin dyspnoea, from Greek dyspnoia from dyspnoos, shortness of breath) or shortness of breath (SOB) is perceived to be difficulty of breathing or painful breathing. It is a common symptom of numerous medical disorders.

Dyspnea on exertion (DOE or exertional dyspnea) indicates dyspnea that occurs (or worsens) during physical activity.

Differentiating Dyspnea from other Conditions

  • Air hunger the sensation of an urgent need to breathe, sensation that you cannot take in a full breath
  • Tachypnea breathing rapidly
  • Bradypnea breathing slowly
  • Eupnea normal unlabored breathing
  • Orthopnea dyspnea that occurs with lying flat
  • Trepopnea an abnormal awareness of one's own breathing that is seen in one lateral position but not in the other
  • Paroxysmal nocturnal dyspnea sudden, severe shortness of breath at night that awakens a person from sleep, often with coughing and wheezing.

Life Threatening Causes of Dyspnea Requiring Urgent Evaluation and Management

Causes

Common Causes

===Causes by Organ System

Cardiovascular Aortic dissection, Cardiomyopathy, Congenital heart disease, Heart failure, Ischaemic heart disease, Malignant hypertension, Diseases of the pericardium such as Cardiac tamponade, Constrictive pericarditis or Pericardial effusion, Pulmonary edema, Pulmonary embolism, Valvular heart disease
Chemical / poisoning No underlying causes
Dermatologic No underlying causes
Drug Side Effect No underlying causes
Ear Nose Throat No underlying causes
Endocrine Hypothyroidism
Environmental No underlying causes
Gastroenterologic No underlying causes
Genetic No underlying causes
Hematologic Anemia, Leukemia
Iatrogenic No underlying causes
Infectious Disease Sepsis
Musculoskeletal / Ortho No underlying causes
Neurologic Amyotrophic lateral sclerosis, Guillain-Barré syndrome, Multiple sclerosis, Myasthenia gravis, Parsonage-Turner syndrome, Eaton-Lambert syndrome
Nutritional / Metabolic No underlying causes
Obstetric/Gynecologic No underlying causes
Oncologic Lung cancer
Opthalmologic No underlying causes
Overdose / Toxicity No underlying causes
Psychiatric Anxiety disorders and panic attacks
Pulmonary No underlying causes
Renal / Electrolyte Metabolic acidosis
Rheum / Immune / Allergy No underlying causes
Sexual No underlying causes
Trauma No underlying causes
Urologic No underlying causes
Miscellaneous No underlying causes

|}

Complete Differential Diagnosis of Causes of Dyspnea

In alphabetical order. [1] [2]

Obstructive lung diseases

Diseases of lung parenchyma and pleura

Contagious

Non-contagious

Pulmonary vascular diseases

Obstruction of the airway

Immobilization of the diaphragm

Restriction of the chest volume


Diagnosic Evaluation

  • History
  • Physical examination: All patients should be evaluated for underlying diseases (especially heart and lung diseases). Detecting of following symptoms and signs are important:

Treatment of the Patient with Dyspnea

Oxygen Supply

Oxygen supply is the essential part of acute dyspnea management.

Exercise Training

Controlled studies have shown that dyspnea upon exertion decreases and exercise tolerance improves in response to exercise training, even in patients with advanced disease. It is now well established that for patients with COPD who remain breathless despite optimal drug therapy, exercise training can confer significant symptomatic benefits.

Pharmacologic Therapy

Two types of medications have proven useful in alleviating dyspnea: opiates and drugs that reduce anxiety. A number of studies have shown that opiates acutely relieve dyspnea and improve exercise performance in patients with COPD.

The drugs to reduce anxiety have the potential to relieve ventilatory response related to the available amounts of oxygen in the blood, as well as by lowering the emotional response to dyspnea.

Fans

The movement of cool air with a fan has been observed to reduce dyspnea in pulmonary patients. A decrease in the temperature of the facial skin alters feedback to the brain and modifies the perception of dyspnea. Cool air has been shown in normal volunteers to reduce dyspnea in response to excess carbon dioxide in the blood.

Altered Breathing Patterns

Breathing retraining including diaphragmatic breathing and pursed lip breathing has been advocated to relieve dyspnea in COPD patients. During a breathing retraining period, many patients adopt slower, deeper breathing techniques; however, they often resort to spontaneous, fast, shallow breathing patterns when the training ends.

Continuous Positive Airway Pressure (CPAP)

In various studies, CPAP has been shown to relieve dyspnea during asthma attacks, when patients are being weaned from ventilators, and during exercise sessions for patients with advanced COPD.

Nutrition

Several investigators have shown improvement in respiratory muscle function in response to short-term use of nutritional repletion by an intravenous route.

Positioning

Patients with COPD often change body position to improve dyspnea. They tend to lean forward to improve overall respiratory muscle strength and to reduce their symptoms.

Steroids

Steroid use can be beneficial to pulmonary patients by reducing airway inflammation and by increasing vital capacity in chronic lung inflammation. However, steroids have adverse effects, including muscle wasting and weakness. These potential problems need to be balanced against possible gains in lung function associated with this drug.

Cognitive-behavioral Approaches In patients with different pain syndromes, distraction, relaxation, and education about symptoms have modified the intensity of pain, increased tolerance, and decreased distress. Improvements in dyspnea and anxiety have been shown to follow distractions such as music during exercise, although long-term effects have been minimal. However, exercise in a monitored, supportive environment has been shown to be a powerful method of overcoming apprehension, anxiety, and/or fear associated with exertional dyspnea.

See also

References

  1. ↑ Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
  2. ↑ Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X

Additional Resources

  • Julie K. Stegman, Stedman's Medical Dictionary, 28th Edition, pages=601, Lippincott Williams & Wilkins, Baltimore, Maryland ISBN 0781733901

Template:Skin and subcutaneous tissue symptoms and signs Template:Nervous and musculoskeletal system symptoms and signs Template:Urinary system symptoms and signs Template:Cognition, perception, emotional state and behaviour symptoms and signs Template:Speech and voice symptoms and signs Template:General symptoms and signs


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