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DYSPNEA
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Dyspnea is an abnormally uncomfortable awareness of breathing

1. Physiologic dyspnea
-
-
-
2. Pathologic dyspnea
2.1 cardiopulmonary causes
2.2 neuromuscular causes myasthenia gravis, muscular diseases, central nervous system
diseases
2.3! chest wall diseases kyphoscoliosis, ankylosing spondylitis
2.4! systemic diseases thyrotoxicosis, hypothyroidism, anemia, uremia
3. Psychogenic dyspnea

apex , , ,

2
cardiac pulmonary dyspnea
,

cardiopulmonary dyspnea
A. ACUTE DYSPNEA
Pulmonary cause
- Obstructive disease
- acute asthma
- acute exarcerbation of COPD
- Restrictive disease
- pneumonia
- pulmonary edema
- pneumothorax
- pleural effusion
- Vascular disease
- pulmonary emboli
Cardiac cause
- acute arrhythmias paroxysmal atrial tachycardia, paroxysmal ventricular tachycardia
- acute myocardial diseases myocarditis, myocardial infarction, cardiac beri-beri
- acute valvular diseases acute bacterial endocarditis, acute rheumatic fever
- acute pericardial diseases pericarditis, cardiac tamponade
B. CHRONIC DYSPNEA
Pulmonary cause
- Obstructive disease
- chronic asthmatic bronchitis
- chronic bronchitis
- emphysema
- Restrictive disease
- pulmonary fibrosis
- pleural effusion

3
- Vascular disease
- recurrent pulmonary emboli
- pulmonary hypertension
Cardiac cause
- chronic arrhythmia atrial fibrillation, AV block
- chronic myocardial diseases cardiomyopathies
- chronic valvular diseases rheumatic heart disease
- chronic pericardial diseases chronic constrictive pericarditis, pericardial effusion
cardiac pulmonary dyspnea
1.
(orthopnea)
(paroxysmal nocturnal dyspnea)
, COPD
( 2-5 )
,
( 5 ) COPD
dyspnea
" " ""

,
( )
pulmonary edema
mitral stenosis

4
(dissiness) (syncope)

dyspnea

2.

- restrictive lung diseases congestive heart failure

- inspiratory dyspnea upper airway obstruction
- expiratory dyspnea lower airway obstruction
- hyperventilation syndrome, , metabolic acidosis

jugular venous pulsation

- Paradoxical pulse pericardial diseases severe obstructive lung diseases
- Kussmaul's sign constrictive pericarditis, severe congestive heart failure, restrictive
cardiomyopathy tricuspid stenosis

- wheezes obstructive airway diseases pulmonary

edema pulmonary emboli
- creptiations 2
dependent part 2
( pulmonary fibrosis, bilateral pneumonia)
- (distant heart sounds) ,

emphysema murmurs, PMI, gallop
cor pulmonale S3
gallop TVA, tricuspid regurgitation P2

cyanosis
clubbing , congenital cyanotic heart disease
3.

, interstitial vascular marking acute chronic changes
perihilar infiltration,
Kerley B line cardiogenic pulmonary edema
(pulmonary function tests)
- restrictive pattern
- COPD, acute asthma obstructive pattern
-
, echocardiography, cardiac scans, right heart catheterization,
, exercise test

dyspnea (therapeutic trial)
2
(, , ) bronchospasm

1. Hemimer D, Schart SM. Smith JR. History and Physical Examination In: Baum G.L, Wolinsky E.W ed.
Textbook of Pulmonary Diseases. 3rd edition. Boston: Little, Brown and Company 1983: 223-233.
2. Braundwald E. The history, the physical examination In: Braunwald E ed. Heart Disease: a textbook of
cardiovascular medicine. 2nd edition. Philadelphia: W.B. Saunders 1984:3-39.
3. Mc. Tachden E.R Jr, Ingram R.H. Relationship between diseases of the heart and lungs. In:
Braunwald E. ed. Heart Disease: a textbook of cardiovascular medicine, 2nd edition. Philadelphia:
W.B. Saunders 1984: 1788-1796.
4. Wasserman K. Dyspnea on exertion: is it the heart or lungs ? JAMA 1982; 248: 2039-2043.
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