Dyspnea - Shortness of Breath Causes

Dyspnea - Shortness of Breath Causes

  1. Acute Dyspnea
    1. Cardiac cause
      1. Decompensated CHF (can result in pulmonary edema)
        1. Hypertensive cardiovascular disease
        2. Coronary artery (arteriosclerotic) heart disease
          • Angina
          • Myocardial infarction(MI)
        3. Cardiomyopathy
          • Dilated – idiopathic, alcohol, infection (virus)
          • Inflammatory (myocarditis, sarcoidosis)
          • Hypertrophic
          • Restrictive/infiltrative – amyloid, hemochromatosis.
        4. Valvular heart disease – left-sided
    2. Pulmonary causes
      1. Acute severe bronchospasm
        • Asthma
        • Anaphylaxis
        • Decompensated CHF
      2. Acute pulmonary embolism.
      3. Pneumothorax

  2. Chronic Dyspnea
    1. Cardiac causes
      1. Left Ventricular (LV) Dysfunction
        • Coronary artery disease
        • Hypertensive heart disease
        • Cardiomyopathy
      2. Valvular heart disease – usually left sided
        • Aortic stenosis – with angina, syncope and atrial fibrillation (AF)
        • Aortic insufficiency
        • Mitral stenosis – pulmonary venous hypertension – dyspnea on exertion, orthopnea and PND, and hemoptysis may occur.
        • Mitral insufficiency
        • Left atrial myxoma blocking the mitral valve
      3. Constrictive pericarditis – dyspnea and peripheral edema

    2. Pulmonary causes (from larynx to alveoli)
      1. Vocal cord dysfunction – central wheezing on inspiration and expiration
      2. Tracheal stenosis
        • Injury due to previous endotracheal intubation
        • Tracheal tumors
      3. Asthma – wheezing.
      4. COPD
        • Chronic asthmatic bronchitis
        • Bronchiectasis
      5. Interstitial lung disease
        • Idiopathic
        • Collagen vascular disease
        • Occupational exposure
      6. Chest wall deformities
        • Severe kyphoscoliosis
      7. Neuromuscular disease
        • Muscular dystrophies
        • Polio survivors
        • Primary neurological diseases – Amyotrophic lateral sclerosis (ALS).
        • Bilateral phrenic nerve paralysis
        • Diaphragmatic paralysis
      8. Pleural effusion
      9. Pulmonary embolus (PE)
      10. Pulmonary vascular disease – other than PE that results in pulmonary hypertension.
        1. Primary – dyspnea, chest pain, syncope, and right heart failure (RHF).
        2. Secondary
          • Drugs
          • HIV
          • Chronic pulmonary thromboembolism
          • Chronic hypoxemia – right to left shunt
          • Obstructive sleep apnea with obesity hypoventilation syndrome.
          • Tumor micro emboli
    3. Severe anemia
    4. Anxiety disorders

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