Dyspnea

Rationale

Dyspnea is a subjective sensation of shortness of breath or difficulty breathing. It is a common and distressful symptom. Acutely, dyspnea may indicate serious life-threatening illness, and it is an important cause of disability when present chronically.

Causal Conditions

(list not exhaustive)

1. Cardiac causes
   1. Myocardial dysfunction (e.g., ischemic cardiomyopathy, heart failure)
   2. Valvular heart disease
   3. Pericardial disease (e.g., tamponade, pericarditis)
   4. Arrhythmia
2. Pulmonary causes
   1. Airway (e.g., asthma, chronic obstructive pulmonary disease)
   2. Parenchymal/interstitial (e.g., pneumonia, atelectasis, pneumonitis, acute respiratory distress syndrome)
   3. Pulmonary vascular (e.g., embolism)
3. Pleural disorders (e.g., pleural effusion, pneumothorax)
4. Other causes (e.g., acidosis, anxiety, anemia, shock, deconditioning, carbon monoxide poisoning, neuromuscular disorder)

Key Objectives

Given a patient with dyspnea, the candidate will diagnose the cause, severity, and complications, and will initiate an appropriate management plan. It is essential to identify patients with life-threatening causes of dyspnea.

Enabling Objectives

Given a patient with acute dyspnea, the candidate will

1. list and interpret critical clinical findings, including those derived from
   1. a relevant history and physical examination, including current airway, breathing, and circulation status;
   2. the determination as to whether the dyspnea is due to cardiac, pulmonary, or other causes; and
   3. a history of occupational and environmental exposures;
2. list and interpret critical investigations (e.g., electrocardiography, arterial blood gases, chest radiography); and
3. construct an effective management plan, including
   1. initiating immediate and emergent management if the patient presents with life-threatening dyspnea;
   2. referring the patient for specialized care if necessary;
   3. planning long-term management in case of chronic dyspnea, including secondary prevention strategies; and
   4. anticipating medium- and long-term complications (e.g., psychosocial effects, safety) in case of chronic dyspnea.