Dyspnea differential diagnosis

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

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

Differential Diagnosis

• 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.

 Shortness of breath/Dyspnea

Organ system			Diseases	Clinical manifestations											Diagnosis					Other features
				Symptoms						Physical exam
				Loss of consciousness	Agitation	Weight loss	Fever	Chest pain	Cough	Cyanosis	Clubbing	JVD	Peripheral edema	Auscultation	CBC	ABG	Imaging	Spirometry	Gold standard
Acute Dyspnea	Respiratory system	Head and Neck, Upper airway	Angioedema	-	-	-	-	-	+/-	-	+/-	-	++	Normal	Normal	↓O2, ↑CO2	Normal	↓Vt, ↑RV	Physical exam	Generalized edema
			Anaphylaxis	+	+	-	+/-	-	-	+/-	-	-	-	Scattered wheeze	Normal	Normal	Normal	↓Vt, ↑RV	Vital sign	Type 1 hypersensitivity
			Aspiration	-	+	-	-	+/-	+	+	-	-	-	Diminished breath sounds	Normal	Normal	Atelectasis	↓Vt, ↑RV	Bronchoscopy	Choking
			Croup	-	+	-	+/-	-	+	+	-	-	-	Stridor	↑WBC	Normal	Steeple sign	Normal	Physical exam	Barking cough
			Epiglottitis	-	+	-	+	-	+	-	-	-	-	Stridor	↑WBC	Normal	Thumb sign	Normal	Laryngoscopy	Drooling
			Rhinosinusitis	-	-	-	+	-	+/-	-	-	-	-	Normal	↑WBC	Normal	Sinus inflammation	Normal	Physical exam	Headache
			Vocal cord dysfunction	-	-	-	-	-	+/-	-	-	-	-	Stridor	Normal	Normal	Normal	↓ FVC	Laryngoscopy	Choking sensation
		Chest and Pleura, Lower airway	Asthma attack	-	+	-	-	+/-	+	+	-	-	-	Wheeze	↑ Eosinophil	Respiratory alkalosis	Normal	↓ FEV1/FVC	Physical exam and Spirometry	Chest pain
			Bronchitis	-	-	-	+	+	+	-	-	-	-	Rhonchi	↑WBC	Normal	Normal	Normal	Physical exam	Rhonchi relieved by cough
			Bronchospasm
			Bronchiolitis
			COPD exacerbation
			Lung carcinoma
			Pneumonia
			Pneumothorax
			Pulmonary embolism
			Rib fractures (flail chest)
	Cardiovascular system		Acute myocardial ischemia
			Acute heart failure
			Pericardial tamponade
			Tachyarrhythmia
			Pulmonary edema
	Central nervous system		Stroke
			Encephalitis
			Traumatic brain injury
	Toxic/Metabolic		Organophosphate poisoning
			Salicylate poisoning
			Carbon monoxide poisoning
			Diabetic ketoacidosis
	Systemic		Panic attack
			Pregnancy
			Sepsis
Organ system			Diseases	Clinical manifestations											Diagnosis					Other features
				Symptoms						Physical exam
				Loss of consciousness	Agitation	Weight loss	Fever	Chest pain	Cough	Cyanosis	Clubbing	JVD	Peripheral edema	Auscultation	CBC	ABG	Imaging	PFT	Gold standard
Chronic Dyspnea	Respiratory system	Head and Neck, Upper airway	Goiter
			Laryngeal adenocarcinoma
			Vocal cord paralysis
			Tracheal stenosis
		Chest and Pleura, Lower airway	Bronchial asthma
			Bronchiectasis
			COPD
			Emphysema
			Pulmonary hypertension
			Interstitial lung disease
			Sarcoidosis
			Alveolitis
			Bronchiolitis obliterans
			Cystic fibrosis
			Pleural effusion
			Pulmonary right-to-left shunt
			Phrenic nerve palsy
			Tuberculosis
	Cardiovascular system		Constrictive pericarditis
			Restrictive cardiomyopathy
			Valvular heart disease
			Bradyarrhythmia
			Pericardial effusion
			Coronary heart disease
			Intracardiac shunt
	Neuromuscular disease		Amyotrophic lateral sclerosis
			Polymyositis/dermatomyositis
			Mitochondrial diseases
			Glycolytic enzyme defects (e.g., McArdle)
	Toxic/Metabolic		Metabolic acidosis
			Renal failure
	Systemic		Anemia
			Anxiety
			Ascites
			Depression
			Kyphoscoliosis
			Obesity
	Autoimmune		Churg-Strauss syndrome
			Microscopic polyangiitis
			Wegener's granulomatosis
			Goodpasture's disease