Dyspnea Causes

Sep 16, 2019 admin HÔ HẤP 0

Dyspnea Causes

Aka: Dyspnea Causes, Causes of Dyspnea with Clear Lung Sounds

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

  1. Anemia
  2. Acute Coronary Syndrome
  3. Pericardial Tamponade
  4. Pulmonary Embolism
  5. Pulmonary Hypertension
    1. Observe for signs of right Heart Failure (edema, JVD)

V. Causes: Acute Dyspnea in Children

  1. Asthma
  2. Pneumonia
  3. Bronchiolitis
  4. Croup
  5. Epiglottitis
  6. Foreign Body Aspiration
  7. Myocarditis

VI. Causes: Airway Causes

  1. Foreign Body Aspiration
  2. Croup
  3. Epstein-Barr Virus
  4. Epiglottitis
  5. Bacterial Tracheitis
  6. Ludwig’s Angina
  7. Retropharyngeal Abscess
  8. Peritonsillar Abscess

VII. Causes: Cardiac Causes

  1. Coronary Artery Disease (Myocardial Infarction)
  2. Congestive Heart Failure
  3. Cardiomyopathy
    1. Myocarditis
    2. Hypertrophic Cardiomyopathy
    3. Left Ventricular Hypertrophy
    4. Asymmetric septal hypertrophy
  4. Valvular dysfunction (e.g. Aortic Stenosis)
  5. Pericarditis
  6. Arrhythmias (e.g. Atrial Fibrillation)

VIII. Causes: Pulmonary Causes

  1. Pneumothorax
  2. Hereditary lung disorders
  3. Pulmonary Embolism
  4. Obstructive Lung Disease
    1. Emphysema
    2. Asthma
    3. Bronchiectasis
      1. Cystic Fibrosis
      2. Post-Pneumonia
      3. Immotile cilia
    4. Obliterative Bronchiolitis
  5. Restrictive Lung Disease
    1. Massive Obesity
    2. Kyphoscoliosis
    3. Congestive Heart Failure
    4. Bronchiolitis Obliterans Organizing Pneumonia (BOOP)
    5. Hypersensitivity pneumonitis
    6. Sarcoidosis
    7. Idiopathic Pulmonary Fibrosis

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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