What is the diagnosis for a 43-year-old patient with a history of high-grade squamous intraepithelial lesion (HSIL), Human Papillomavirus (HPV) positivity, Hypertension (HTN), and anxiety, presenting with increasing dyspnea (shortness of breath) on exertion since March 12, 2025?

From the Guidelines

This patient's shortness of breath with exertion, in the context of existing anxiety, should be initially evaluated for potential hyperventilation syndrome, as this condition can present with exertional dyspnea and is often associated with anxiety and stress 1. Given the patient's history of anxiety, it is crucial to consider the possibility of hyperventilation syndrome, which can mimic other conditions such as cardiac or pulmonary issues. The patient's symptoms of increasing shortness of breath with exertion since March 12,2025, should be thoroughly evaluated. The already ordered chest X-ray, laboratory tests, and cardiology referral are essential steps in diagnosing the cause of the patient's shortness of breath. While awaiting these results, the patient should:

• Monitor and document their symptoms, including when shortness of breath occurs, its severity, and any associated symptoms like chest pain, coughing, or swelling in the legs.
• Be advised to seek immediate emergency care if they experience severe shortness of breath, chest pain, dizziness, or fainting.
• Continue taking all prescribed medications for their existing conditions, including hypertension and anxiety.
• Consider blood pressure monitoring at home, given their history of hypertension. During today's clinic visit, vital signs should be carefully assessed, including oxygen saturation, and a focused cardiopulmonary examination should be performed to help differentiate between potential causes of the patient's symptoms, including cardiac issues, pulmonary problems, anemia, deconditioning, or anxiety exacerbation, as suggested by the ats/accp statement on cardiopulmonary exercise testing 1.

From the Research

Patient's Symptoms and Medical History

• The patient is a 43-year-old woman with a medical history of high-grade squamous intraepithelial lesion (HSIL), positive HPV on a gynecological exam, hypertension (HTN), and anxiety.
• The patient's current concern is increasing shortness of breath (SOB) with exertion, which started on March 12,2025.
• A chest X-ray, laboratory tests, and a cardiology referral have been ordered but not yet completed.

Possible Causes of Shortness of Breath

• According to 2, chronic dyspnea can be caused by various factors, including asthma, heart failure, myocardial ischemia, chronic obstructive pulmonary disease, interstitial lung disease, pneumonia, or psychogenic disorders.
• The study 3 suggests that shortness of breath on exertion can be caused by pulmonary arteriovenous fistula, pulmonary arterial hypertension, lung cancer, partial anomalous pulmonary venous connection, or isolated tricuspid regurgitation.
• The patient's symptoms of shortness of breath on exertion are similar to those described in 4, where a 51-year-old woman with a history of diabetes mellitus and anemia experienced rapidly progressive dyspnea.

Diagnostic Approach

• The study 2 recommends initial testing for patients with chronic dyspnea, including chest radiography, electrocardiography, spirometry, complete blood count, and basic metabolic panel.
• Measurement of brain natriuretic peptide levels and D-dimer testing may help exclude heart failure and pulmonary emboli, respectively 2.
• Computed tomography of the chest is the most appropriate imaging study for diagnosing suspected pulmonary causes of chronic dyspnea 2.
• The study 5 emphasizes the importance of considering the clinical presentation and underlying cause when evaluating and managing dyspnea.

Anxiety and Hyperventilation

• The patient's anxiety may be contributing to her shortness of breath, as anxiety can lead to hyperventilation syndrome 6.
• The study 6 found that beta-blocker therapy with metoprolol can be effective in treating hyperventilation syndrome.