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    Dyspnoea Ddx/Associated Features Body System/key Qs Acute

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    dragtoss2
    This document provides information to help differentiate the causes of acute and chronic dyspnoea. For acute dyspnoea, common pulmonary causes include pneumonia, pulmonary embolism, asthma, and COPD exacerbations. Cardiac causes include heart attack, angina, heart failure, and arrhythmias. Other potential causes are anxiety and anaphylaxis. Chronic dyspnoea may be due to obstructive or restrictive lung diseases, heart failure, stable angina, or anemia. A thorough history, physical exam, and testing can help identify the underlying condition. Exam findings like breath sounds, percussion notes, and vocal resonance provide clues to diagnoses like pneumonia, pleural effusions, and COPD.

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    Dyspnoea Ddx/Associated Features Body System/key Qs Acute

    Uploaded by

    dragtoss2
    123 views4 pages
    This document provides information to help differentiate the causes of acute and chronic dyspnoea. For acute dyspnoea, common pulmonary causes include pneumonia, pulmonary embolism, asthma, and COPD exacerbations. Cardiac causes include heart attack, angina, heart failure, and arrhythmias. Other potential causes are anxiety and anaphylaxis. Chronic dyspnoea may be due to obstructive or restrictive lung diseases, heart failure, stable angina, or anemia. A thorough history, physical exam, and testing can help identify the underlying condition. Exam findings like breath sounds, percussion notes, and vocal resonance provide clues to diagnoses like pneumonia, pleural effusions, and COPD.

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    SOB workup - common DDx and Hx

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    Dyspnoea

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    This document provides information to help differentiate the causes of acute and chronic dyspnoea. For acute dyspnoea, common pulmonary causes include pneumonia, pulmonary embolism, asthma, and COPD exacerbations. Cardiac causes include heart attack, angina, heart failure, and arrhythmias. Other potential causes are anxiety and anaphylaxis. Chronic dyspnoea may be due to obstructive or restrictive lung diseases, heart failure, stable angina, or anemia. A thorough history, physical exam, and testing can help identify the underlying condition. Exam findings like breath sounds, percussion notes, and vocal resonance provide clues to diagnoses like pneumonia, pleural effusions, and COPD.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    123 views4 pages

    Dyspnoea Ddx/Associated Features Body System/key Qs Acute

    Uploaded by

    dragtoss2
    This document provides information to help differentiate the causes of acute and chronic dyspnoea. For acute dyspnoea, common pulmonary causes include pneumonia, pulmonary embolism, asthma, and COPD exacerbations. Cardiac causes include heart attack, angina, heart failure, and arrhythmias. Other potential causes are anxiety and anaphylaxis. Chronic dyspnoea may be due to obstructive or restrictive lung diseases, heart failure, stable angina, or anemia. A thorough history, physical exam, and testing can help identify the underlying condition. Exam findings like breath sounds, percussion notes, and vocal resonance provide clues to diagnoses like pneumonia, pleural effusions, and COPD.

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    of 4

    DYSPNOEA

    DDx/ASSOCIATED FEATURES

    Body system/key qs
    ACUTE Pulmonary causes:
     Pneumothorax: abrupt, sharp CP, tachypnoea, diminished breath sounds
     PE: sharp chest pain, tachypnoea, tachycardia, RFs for PE
     Asthma, bronchospasm or reactive airway disease: wheezing, trigger present
     Foreign body inhalation: sudden onset of cough or stridor in a patient without URTI or
    constitutional Sx
     Pneumonia: fever, productive cough, pleuritic chest pain
     COPD exacerbation: cough, accessory muscle use or pursed lip breathing

    Cardiac causes:
     AMI: substernal chest pressure which may radiate to arm/jaw, CVD RF present
     Angina or IHD: substernal chest pressure which may radiate to arm/jaw, provoked by physical
    exertion, presence of CVD RFs
     Papillary muscle dysfunction/rupture: new/loud holosystolic murmur, signs of HF, recent MI
     HF (APO): crackles, S3 gallop, elevated JVP, peripheral oedema
     Arrhythmia
     Pericardial effusion or tamponade: muffled heart sounds

    Other
     Anxiety disorder: situational dyspnoea accompanied by psychomotor agitation and
    paraesthesia in the fingers or around the mouth
     Anaphylaxis: PMHx, medication use, swelling/facial oedema
     Metabolic acidosis: e.g. DKA

    CHRONIC Pulmonary causes:


     Obstructive lung disease
     Restrictive lung disease: progressive dyspnoea in patients with known occupational exposure
    of neurologic condition
     ILD: fine crackles, dry cough
     Pleural effusion: pleuritic chest pain, Hx of cancer, HF, RA, SLE or acute pneumonia
     TB: signs of infection, travel to/from TB endemic country

    Cardiac causes:
     HF
     Stable angina

    Other:
     Anaemia: dyspnoea on exertion progressing to dyspnoea at rest, sometimes systolic flow
    murmur, syncope, fatigue, heavy periods, ↓exercise tolerance

    OTHER
    BODY SYSTEM DDx
     Cardiovascular:
    o IHD
    o CCF (+ acute exacerbation)
     infection, ischaemia/infarction, anaemia, arrhythmia, fluid overload (non-compliance to fluid
    restriction), non-compliance to medications, Na+ retaining drugs e.g. (aspirin or steroids)
    o Cardiac tamponade
    o Aortic dissection
    o Pericarditis
     Respiratory:
    o PE
    o Pneumothorax
    o Acute asthma attack
    o IECOPD
    o Lung/pleural malignancy
    o Pneumonia
    o Diffuse lung disease
    o IPF, asbestosis, sarcoidosis, drugs (e.g. methotrexate, nitrofurantoin, amiodarone, isoniazid)
    o RTI
     Haematological:
    o Anaemia
    o Haematological (or any) malignancy
     Others:
    o DKA
    o Allergy/anaphylaxis
    o Sepsis
    o GORD
    o MND/GBS/MG
    o Anxiety and panic disorders
    o Hyperthyroidism (triggering AF)

    Investigations
     Bedside/Bloods
    o FBE: Hb (anaemia), WCC (infection, leukaemia), CRP (inflammatory)
    o Random blood glucose (DKA)
    o Cardiac enzymes/ECG: troponin, CK (AMI)
    o Sputum M/C/S (microscopy, culture, sensitivity), nasopharyngeal swab
     Blood cultures (?pneumonia)
     Imaging
    o CXR (pneumonia, pneumothorax)
    o CT pulmonary angiogram (PE)
    o CT chest (malignancy)
    o Echo (CCF)
     Other
    o Pulmonary function tests (asthma, COPD, IPF)

    OTHER NOTES
    Well’s Score
    Measures risk of PE:
     Signs and symptoms of DVT (3)
     PE is the most likely diagnosis (3)
     Tachycardia >100bpm (1.5)
     Immobilisation > 3 days of surgery in last 4 weeks (1.5)
     Previously diagnoses DVT or PE (1.5)
     Haemoptysis (1)
     Malignancy diagnosed within past 6 months (1)

    Cardinal Features of Dyspnoea


    Feature Note/Significance
    Site -
    Quality Are you having trouble getting air in or out? Wheeze/tightness?
    Severity Are you short of breath normally/at rest?
    Impact on daily activities?
    How far can you walk?
    How many flights of steps?
    Orthopnoea/PND? How many pillows? CHF severity, OSA
    Time course Duration? Onset/offset? Fluctuations/progression? Past episodes?
    Context Lung/heart problems? (Asthma, COPD, HF)
    Sick contacts/travel? (Infection, TB endemic countries)
    Chest trauma? (Pneumothorax)
    Surgery/immobility/flight/clotting disorders? (DVT/PE)
    Swallowed down wrong way? (Obstruction/aspiration pneumonia)
    Diabetes? (Silent MI)
    Exposure to asbestos or harsh chemicals? (Asbestosis)
    Relieving Puffer?
    factors Rest?
    Aggravating Lying flat? Exertion?
    factors Asthma triggers?
    Associated  AMI: central crushing CP, sweaty, N/V, palpitations, syncope, intermittent claudication
    features  CCF: chest pain, peripheral oedema, orthopnoea, PND
     Aortic dissection: dizzy/lightheaded, CT disorders

     PE/DVT: pleuritic chest pain, unilateral leg swelling/tenderness (RFs of DVT), clotting Hx
     Pneumothorax: young skinny male, sudden onset
     Pneumonia/malignancy: cough, sputum, haemoptysis, fevers, night sweats, fatigue
     Asthma/COPD: wheeze, pursed-lip breathing, fever (if infective)
     RTI: coryzal symptoms (sore throat, runny nose, cough etc.)

     Anaemia: fatigue, dizziness upon standing, palpitations, syncope


     GORD: reflux
     Stress and anxiety
    PMHx CVD (and RFs)
    Coagulopathies, OCP (PE)

    Asthma/COPD Hx
    Vaccinations (Infection/COPD exacerbation)
    Smoking (COPD)

    Cancer
    GORD
    Allergies/atopy (Anaphylaxis)
    OTHER/RED  Severe chest pain – AMI, PE Clinical pearls:
    FLAGS/CLINICL  Haemoptysis – lung malignancy, PE Pneumonia and normal CXR? → LATERAL
    A PEARLS  Night sweats – TB CXR b.c can’t see behind the heart
     Splenomegaly – leukaemia
     Fever, tachycardia, hypotension – sepsis Bilateral symmetrical findings: CHF/APO
     Hypotension and rash – sepsis
     Weight loss – malignancy
    EXAMINATION Cardiovascular examination
    Respiratory examination
    Haematological examination

    Respiratory exam findings

     Percussion note
    o Dull – solid organ or fluid
    o Resonant – normal aerated lung
    o Hyper-resonant – air (hyperinflated lung or air in pleural space)
     Breath sounds
    o Quality
     Normal/vesicular (inspiratory > expiratory without interposed gap)
     Bronchial breathing (prolonged during expiration, harsher – filled alveoli)
    o Intensity
     ↓/muffled breath sounds (pleural effusion, pneumonia, COPD, pneumothorax, mass)
    o Added sounds
     Polyphonic wheeze (EXPIRATORY, asthma, COPD – airway narrowing)
     Monophonic wheeze (EXPIRATORY, SOL - fixed obstruction)
     Stridor (INSPIRATORY, upper airway obstruction)
     Crackles (opening of small airways)
     Early inspiratory – COPD
     Later/pan-inspiratory – alveolar disease
     Fine crackles/Velcro – IPF
     Medium crackles – LV failure
     Coarse crackles – bronchiectasis (retained secretions)
     Pleural rub (pleuritis - inflamed pleura rub against each other, 2ndary to pneumonia, infarct)
     Vocal resonance/vocal fremitus
    o ↑vocal resonance = ↑ tissue density
    o ↓vocal resonance = ↑air present/fluid in pleural space

    Condition Percussion note Breath sounds Vocal resonance


    Pneumonia/APO Dull Bronchial breath sounds ↑
    Pleural effusion Dull ↓breath sounds ↓
    Pneumothorax Hyperresonant ↓breath sounds ↓
    COPD Hyperresonant Polyphonic wheeze, early ↓
    inspiratory crackles

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