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Review
. 2016 Dec 9;113(49):834-845.
doi: 10.3238/arztebl.2016.0834.

The Differential Diagnosis of Dyspnea

Dominik Berliner  1 , Nils Schneider, Tobias Welte, Johann Bauersachs
Affiliations
Review

The Differential Diagnosis of Dyspnea

Dominik Berliner et al. Dtsch Arztebl Int. .

Abstract

Background: Dyspnea is a common symptom affecting as many as 25% of patients seen in the ambulatory setting. It can arise from many different underlying conditions and is sometimes a manifestation of a life-threatening disease.

Methods: This review is based on pertinent articles retrieved by a selective search in PubMed, and on pertinent guidelines.

Results: The term dyspnea refers to a wide variety of subjective perceptions, some of which can be influenced by the patient's emotional state. A distinction is drawn between dyspnea of acute onset and chronic dyspnea: the latter, by definition, has been present for more than four weeks. The history, physical examination, and observation of the patient's breathing pattern often lead to the correct diagnosis, yet, in 30-50% of cases, more diagnostic studies are needed, including biomarker measurements and other ancillary tests. The diagnosis can be more difficult to establish when more than one underlying disease is present simultaneously. The causes of dyspnea include cardiac and pulmonary disease (congestive heart failure, acute coronary syndrome; pneumonia, chronic obstructive pulmonary disease) and many other conditions (anemia, mental disorders).

Conclusion: The many causes of dyspnea make it a diagnostic challenge. Its rapid evaluation and diagnosis are crucial for reducing mortality and the burden of disease.

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Figures

Figure 1
Figure 1
The diagnostic evaluation of chronic dyspnea, modified from (3, 9, 22, 24) BNP: brain natriuretic peptide CT: computed tomography ECG: electrocardiography FEV1: forced expiratory volume in 1 second Hb: Hemoglobin IVC: inspiratory vital capacity MRI: magnetic resonance imaging NT-proBNP: N-terminal prohormone brain natriuretic peptide TSH: thyroid-stimulating hormone
Figure 2
Figure 2
Echocardiographic criteria for congestive heart failure with reduced or preserved left ventricular ejection fraction (HFrEF and HFpEF, respectively) and the new category with so-called mid-range ejection fraction (HFmrEF); modified from (17, 38). LV: left ventricular LVEF: left ventricular ejection fraction LAVI: left atrial volume index LVMI: left ventricular mass index (?*: =115 g/m² for men, = 95 g/m² for women) E: maximal speed of E-wave in inflow profile over the mitral valve A: maximal speed of A-wave in inflow profile over the mitral valve e’(mean): mean maximal (early) diastolic speed of the septal and lateral mitral valve annulus (tissue Doppler)
See this image and copyright information in PMC

Comment in

References

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