II. Causes: Categories of Dyspnea

  1. Oxygen Ingress problem
    1. High altitude
    2. Airway Obstruction
      1. Larynx or trachea (e.g. Laryngitis, Trauma)
      2. Bronchi (e.g. Acute Bronchitis, Asthma)
      3. Alveoli (e.g. Emphysema, Interstitial Lung Disease)
      4. External compression (e.g. Pneumothorax)
      5. Thoracic wall (e.g. Scoliosis)
  2. Oxygen Uptake problem
    1. Lung circulation
      1. Pulmonary Embolism
      2. Congestive Heart Failure (left side)
      3. Pulmonary Hypertension
    2. Hemoglobin disorder (oxygen carrying capacity)
      1. Anemia
      2. Carbon Monoxide Poisoning
      3. Methemoglobinemia
  3. Neuromuscular problem
    1. Hyperventilation
    2. Increased Intracranial Pressure
  4. Miscellaneous causes
    1. Perceived Dyspnea (e.g. anxiety)
    2. Metabolic Acidosis (with compensatory Tachypnea)

III. Causes: Common in Adults

  1. Acute Dyspnea in Adults (Mnemonic: PPOPPA)
    1. Pulmonary Embolism
    2. Pulmonary edema
      1. Pulmonary: Noxious gas inhalation, HAPE
      2. Cardiogenic: Congestive Heart Failure
    3. Obstructed Airway (Foreign body, Epiglottitis)
    4. Pneumothorax (Spontaneous)
    5. Pneumonia
    6. Asthma or COPD
  2. Chronic Dyspnea in Adults (Duration >1 month)
    1. Obstructive Lung Disease (COPD, Asthma)
    2. Restrictive Lung Disease
      1. Interstitial Lung Disease
      2. Kyphoscoliosis
      3. Neuromuscular disease (e.g. Myasthenia Gravis)
    3. Congestive Heart Failure
    4. Pneumonia
    5. Anemia
    6. Myocardial Ischemia
    7. Hypothyroidism
    8. Upper airway conditions
    9. Obesity
    10. Psychiatric cause (e.g. Anxiety Disorder)

IV. Causes: Dyspnea with Clear Lung Sounds

VIII. Causes: Pulmonary Causes

IX. Causes: Mixed Cardiac or pulmonary causes

  1. COPD with Pulmonary Hypertension and Cor Pulmonale
  2. Deconditioning
  3. Chronic pulmonary emboli
  4. Chest Trauma

X. Causes: Miscellaneous

  1. See Medication Causes of Dyspnea
  2. Metabolic Acidosis (with compensatory Tachypnea)
    1. Includes Aspirin Overdose (Salicylate Toxicity)
  3. Severe Pain
  4. Neuromuscular disorders
    1. Myasthenia Gravis
    2. Amyotropic Lateral Sclerosis
  5. Ear, nose and throat disorders (airway obstruction)
  6. Psychogenic Causes
    1. Anxiety Disorder
    2. Panic Disorder
    3. Hyperventilation

XI. References

  1. Braithwaite in Marx (2002) Rosen's Emergency, p. 155-62
  2. Degowin (1987) Diagnostic Exam, p. 281-2
  3. Fangman in Noble (2001) Primary Care, p. 175-8
  4. Friedman (1991) Problem-Oriented Diagnosis, p. 134-42
  5. Marini (1987) Respiratory Medicine, p. 40-41
  6. Stulbarg in Murray (2000) Respiratory Med, p. 541-52
  7. Zoorob (2003) Am Fam Physician 68(9):1803-10 [PubMed]

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