From the Guidelines
Dyspnea, or shortness of breath, is primarily caused by underlying cardiac or pulmonary diseases.
Common Causes of Dyspnea
- Cardiac causes, such as myocardial disease, valvular heart disease, arrhythmia, and pericardial pathology 1
- Pulmonary causes, which can include a wide range of respiratory conditions
Mechanisms and Assessment
Dyspnea is a complex symptom with contributions from physiologic, psychological, and environmental factors 1. The diagnosis of dyspnea involves a careful history taking and physical examination, as well as diagnostic investigations such as chest radiography, electrocardiography (ECG), and laboratory testing 1.
Clinical Approach
Identifying the cause of dyspnea is crucial for effective treatment, and advanced diagnostic imaging may play a critical role in cases where the cause is unclear 1. The presence of dyspnea is a potent predictor of mortality and often surpasses common physiological measurements in predicting the clinical course of a patient 1.
From the Research
Causes of Dyspnea
The causes of dyspnea, or shortness of breath, are manifold and can arise from various underlying conditions. Some of the common causes include:
- Cardiac and pulmonary disease, such as congestive heart failure, acute coronary syndrome, pneumonia, and chronic obstructive pulmonary disease (COPD) 2, 3, 4
- Other conditions, including anemia, mental disorders, and lung cancer 3, 4
- Physiological, pathological, or social origins, which can lead to increased work of breathing, stimulation of receptors, and excessive stimulation of the respiratory centre 5
Pathophysiology of Dyspnea
The pathophysiology of dyspnea is complex and involves the activation of several pathways, including:
- Increased work of breathing
- Stimulation of receptors in the upper or lower airway, lung parenchyma, or chest wall
- Excessive stimulation of the respiratory centre by central and peripheral chemoreceptors 5
- Neural pathways that transmit the "dyspnea message" from the respiratory apparatus to integrating centers in the brain 6
Clinical Evaluation and Approach
The clinical evaluation and approach to the management of dyspnea are directed by the clinical presentation and underlying cause. The diagnosis can be more difficult to establish when more than one underlying disease is present simultaneously 3. Various subjective clinical and psychophysical scales and questionnaires are typically used to measure or predict dyspnea 2.