Shortness of breath resident survival guide

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

Shortness of breath resident survival guide Microchapters
Overview
Classification
Causes
FIRE
Diagnosis
Treatment
Do's
Dont's

Overview

Dyspnea is a common and often debilitating symptom that affects up to 50% of patients admitted to acute, tertiary care hospitals and a quarter of patients seeking care in ambulatory settings. The presence of dyspnea is a potent predictor of mortality, often surpassing common physiological measurements in predicting the clinical course of a patient. Respiratory discomfort may arise from a wide range of clinical conditions, but also may be a manifestation of poor cardiovascular fitness in our increasingly sedentary population. Diagnosis and treatment of the underlying cause of dyspnea is the preferred and most direct approach to ameliorating this symptom, but there are many patients for whom the cause is unclear or for whom dyspnea persists despite optimal treatment. We define dyspnea as “a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity.” Because dyspnea is a symptom (i.e., perception of an abnormal or distressing internal state), it must generally be distinguished from signs that clinicians typically invoke as evidence of respiratory distress, such as tachypnea, use of accessory muscles, and intercostal retractions.

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.

Common Causes

FIRE

A Focused Initial Rapid Evaluation (FIRE) should be performed to identify patients in need of immediate intervention.

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Complete Diagnostic Approach

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Treatment

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References