Download presentation
Presentation is loading. Please wait.
1
Dyspnea: Differential Diagnosis
Cyril Štěchovský Dept. of Cardiology 2.LF UK a FNM
2
Dyspnea Symptom – shortness of breath
Sign – abnormal respiratory effort
3
Dyspnea is a symptom of disorder at different levels
Central nervous system Ventilation Diffusion Pulmonary perfusion Oxygen transportation Cellular oxygenation
4
Central disorders Hypoxemia Hypercapnia Stroke Encephalitis Tumor
Intoxication Anxiety
5
Disorders of ventilation and diffusion
Neuromuscular disorders Trauma Exhaustion Airway obstruction Laryngospasm COPD Bronchial asthma Tumor Foreign body Restrictive pulmonary disorders - fibrosis Atelectasis Pneumonia Pulmonary congestion / edema Fluidothorax Pneumothorax Esophageal hernia Pulmonary resection Chest deformity High diaphragm
6
Disorders of pulmonary perfusion
Pulmonary embolism Pulmonary hypertension
7
Disorders of oxygen transportation and utilization
Anemia Methemoglobinemia Carboxyhemoglobinemia Cyanide intoxication
8
Others Pain Decondition Hyperthyreosis Fever
9
Pulmonary edema Fluid excess in pulmonary interstitium and alveoli
10
Pulmonary edema Cardiac – increased LVEDP (PCWP)
Noncardiac (ARDS) – inflammation, „leaky“ alveolocapillary membrane Inhaled toxins, aspiration, sepsis, oxygen toxicity, pancreatits, traumatic shock
11
DDx Pulse oximetry Chest x-ray History Physical examination
Paleness (anemia), cyanosis Respiratory rate, heart rate, BP, body temperature Respiratory effort Lungs and heart auscultation Peripheral edema Pulse oximetry Chest x-ray
12
DDx Complete blood count ECG Arterial blood gases ECHO Spirometry
Chest CT scan Spiroergometry
13
Arterial blood gases analysis
pH Saturation pO2 pCO2 Bicarbonate Lactate Anion gap Base excess Hemoglobin
14
Case 1 76-yo male w. dyspnea and chest pain BP 95/72mmHg Hgb 138g/l
SpO2 7,9 kPa SpCO2 3,1 kPa Lactate acidosis TnI 6800 ng/l
15
Case 1 – acute left heart failure with cardiogenic shock
16
Case 2 - COPD 62-yo male w. dyspnea and cough and expectoration
BP 155/75mmHg T 37,2C Hgb 168g/l SpO2 8,2 kPa SpCO2 7,1 kPa CRP 75 mg/l NT-proBNP 1050 ng/l Hypertension, LV hypertrophy, LV diastolic dysfunction, mild pulmonary hypertension, biatrial dilatation.
17
Case 3 – pulmonary embolism
52-yo female w. dyspnea and chest pain BP 115/85 mmHg tachypnea SpO2 8,1 kPa SpCO2 2,4 kPa pH 7,49 – respiratory alcalosis D-dimer 2800µg/l
18
Case 3 – pulmonary embolism
Max. Gradient on TR 48mmHg PASP ≈ 60mmHg
19
Case 4 – decompensed chronic heart failure
58-yo male w. dyspnea nad large periferal oedema BP 142/89mmHg Hgb 106g/l SpO2 10,8 kPa SpCO2 5,4 kPa TnI 870 ng/l INR 4,8 Elevated liver enzymes, bilirubin eGFR 45ml/m2/min
20
Case 4 – decompensed chronic heart failure
21
Case 5 – sepsis with acidosis
75-yo female w. dyspnea, fewer, altered mental status and back pain BP 98/66mmHg T 38,4C Hgb 88g/l SpO2 7,5 kPa SpCO2 3,0 kPa pH 7,18, lactate 6,5mmol/l WBC , left shift CRP 345 mg/l eGFR 25ml/m2/min
22
Case 6 – aortic stenosis 82-yo female w. dyspnea and syncope
BP 178/96mmHg SpO2 11,5 kPa SpCO2 5,2 kPa
23
Case 6 – aortic stenosis Vmax. 4,29m/s
Graient on aortic valve 74/44mmHg
24
Take home message Dyspnea is a common symptom.
Physical examination, ECG, chest x-ray and echocardiography make most of the ddx. Always test arterial blood gases in acute patients.
Similar presentations
© 2025 SlidePlayer.com. Inc.
All rights reserved.