Some Causes of Chronic* Dyspnea
Cause | Suggestive Findings | Diagnostic Approach† |
|---|---|---|
Pulmonary causes | ||
Progressive dyspnea in patients with known occupational exposure Fine crackles, frequently accompanied by dry cough Clubbing Family history | High-resolution chest CT Pulmonary function testing | |
Extensive smoking history, barrel chest, and poor air entry and exit | Chest x-ray Pulmonary function testing (at initial evaluation) | |
Pleuritic chest pain, lung field that is dull to percussion and has diminished breath sounds Sometimes history of cancer, heart failure, rheumatoid arthritis, systemic lupus erythematosus, or acute pneumonia | Chest x-ray Often chest CT and thoracentesis | |
Neuromuscular disease | Progressive dyspnea in patients with a known neuromuscular impairment (eg amyotrophic lateral sclerosis or muscular dystrophies) | Pulmonary function testing EMG or nerve conduction testing Sometimes blood tests to determine the cause |
Cardiac causes | ||
Crackles, S3 gallop, and signs of central or peripheral volume overload (eg, elevated neck veins, peripheral edema) Orthopnea or paroxysmal nocturnal dyspnea | Chest x-ray Echocardiography | |
Loud S2, parasternal heave, elevated jugular venous pressure, murmur of tricuspid regurgitation | Echocardiography Right heart catheterization | |
Substernal chest pressure with or without radiation to the arm or jaw, often provoked by physical exertion, particularly in patients with risk factors for CAD | ECG Cardiac stress testing Sometimes cardiac catheterization | |
Other causes | ||
Normal lung examination and pulse oximetry measurement Sometimes systolic heart murmur due to increased flow | Complete blood count | |
Physical deconditioning | Dyspnea only on exertion in patients with sedentary lifestyle | Clinical evaluation |
* Chronic dyspnea that has lasted for weeks to years. In many of these disorders, dyspnea is initially present on exertion before progressing to dyspnea at rest. | ||
† Most patients should have pulse oximetry and, unless symptoms are clearly a mild exacerbation of a known chronic disease, chest x-ray. | ||
CAD = coronary artery disease; EMG = electromyography; S2 = second heart sound; S3 = third heart sound. | ||