What are the differential diagnoses of dyspnea?

Introduction of dyspenea: what is dyspena or shortness of breath

  • What is dyspnea?
  •  Shortness of breath causes and ddx?

Table of contents(toc)

Dyspena is a condition in which a person feels difficulty breathing.

It is a subjective experience expressed   by the patient. The casuse or origin of this may come formvarying reasons including physiological, psychological, social, and environemntal factors.

Thus produced discomfort now is tackled by our physiological response as change in physiological parameters or behavioral modofications including shortnes of breathing. 

Dyspnoea can be classified as acute or chronic. 

Acute dyspnoea develops withing hours to days while chronic develops over weeks to lnger duration. The causes of acute and  chronic dyspnoea might be different depending upon the duration. 

Pulse oxymeter
Pulse oxymeter

After careful history taking and examination of the patient having dyspnoea we should make a good list of differential disagnoses. The various differential diagnoses of dyspnoea are summerized in the following list. 

The source of causes dyspnea, shortness of breath can be listed as:

  1. Cardiovascular and realted to use of oxygen
  2. Resporatory and chest wall pathology
  3. Psychogenic

Differential diagnoses of dyspnoea/shortness of breath:

1. Causes of acute SOB

  • Cardiovascular

  1. Cardiogenic
  2. Impaired oxygen delivery
  3. Impaired oxygen use

  • Respiratory causes 

  1. Upper airway
  2. Lower aiway causes

  • Psychogenic

  1. panic disorder
  2. conversion disorder
  3. drug withdrawal

2. Causes of Chronic SOB

  • Cardiovascular cause

  1. CHF
  2. Pericarditis
  3. Anemia

  • Respiratory causes

  1. Pathologies of chest wall, bronchoalveolar system, airways and lung parenchyma

The diseases can be summarised as below:

1. Cardiovascular
  • Acute MI
  • CHF/ LH failure
  • Aortic/Mitral stenosis
  • Aortic/Mitral Regurgitation
  • Arrhythmia
  • Cardiac tamponade
  • Constrictive pericarditis
  • Left sided obstructive lesions (atrial myxoma)
  • Elevated pulmonary venous pressure
2. Respiratory
    i) Airway
  • Asthma
  • COPD
  • Upper airway obstruction like foreign body, anaphylaxis, mucus plugging
    ii) Parenchymal disease
  • ARDS
  • Pneumonia
  • ILD
    iii) Pulmonary vascular disease
  • PE
  • Pulmonary HTM
  • Pulmonary vasculitis
    iv)Pleural disease
  • Pneumothorax
  • Pleural effusion
3. Neuromuscular and chest wall disorers
  • C-spine injury
  • Poliomyelitis
  • Myesthenia gravis
  • Gullian-Barre syndrome
  • Kyphoscoliosis
4. Anxiety, psychosomatic
5. Hematological and metabolic
  • Anemia
  • Acidosis
  • Hypercapnia
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