Differential diagnosis of dyspnea/PGS (VPL)

Shortness of definition
Dyspnea is a subjective feeling of the need for increased respiratory effort. It is one of the main symptoms in pneumology.

Degrees of shortness of breath - classification according to WHO
'1st degree - shortness of breath when walking quickly on the level, walking uphill, up stairs.

2nd degree - gets short of breath when walking normally on level ground with peers.

3rd degree - must stop and breathe while walking on the level while walking at his own pace.

4th degree - short of breath at rest.

Differential diagnosis
Intrathoracic causes:
 * cardiac etiology (most often);
 * detailed diff. dg. and the diagnostic procedure of cardiac-related shortness of breath;
 * treatment of acute pulmonary edema;
 * chest;
 * obesity;
 * scoliosis;
 * accident;
 * rib fracture;
 * bronchial etiology;
 * asthma bronchiale;
 * COPD;
 * foreign body aspiration (more often in the upper respiratory tract);
 * bronchogenic carcinoma;
 * pulmonary parenchyma;
 * hypoxemia when the area where gases diffuse is reduced, due to the increase in dead space;
 * emphysema;
 * atelectasis;
 * partial lung resection;
 * pneumonia;
 * extension of diffusion at;
 * pulmonary fibrosis;
 * Wegener's granulomatosis;
 * silicosis;
 * pleura;
 * pneumothorax;
 * hydrothorax;
 * hemothorax;
 * pleural tumor;
 * mesothelioma;
 * pulmonary vessels;
 * pulmonary embolism;
 * pulmonary infarction;
 * neck disease - stenotic;
 * swelling of the vocal cords;
 * narrowing of the trachea (due to oppression – goiter…).

Extrathoracic causes:
 * oxygen transport disorders;
 * chronic anemia – at Hb 50–80 g/l;
 * CO poisoning, HCN poisoning;
 * hyperventilation syndrome - psychogenic tachypnea causes respiratory alkalosis and tetany;
 * metabolic acidosis;
 * compensatory hyperventilation (e.g. in diabetic coma…);
 * uremia (deepened intensive breathing without pauses, Kussmaul breathing);
 * shock;
 * central nervous system;
 * encephalitis;
 * brain tumor;
 * CNS ischemic damage;
 * overdose of barbiturates (Cheyne-Stokes respiration);
 * neuromuscular etiology;
 * myasthenia gravis;
 * Guillain-Barré syndrome;
 * poliomyelitis;
 * amyotrophic lateral sclerosis;
 * paresis nervus phrenicus;
 * poisons – strychnine, curare, anticholinesterase toxins;
 * tetanus;
 * botulism;
 * inhalation damage;
 * poisoning by smoke from a fire or during welding;
 * Th.: inhalation of a corticoid (beclometasone, budesonide, fluticasone, flunisolide) – 500–1000 μg repeatedly after 10 minutes, until the difficulties subside (it is best to apply with a "walker" – fewer errors when applying by the patient);
 * send to hospital immediately.

Diagnostics (briefly)

 * Medical history – lung or heart disease, attacks of shortness of breath (asthma bronchiale...), difficulties at night or during the day, seasonal occurrence of difficulties (allergic asthma...);
 * physical examination of the lungs;
 * examination of the cardiovascular system;
 * ECG examination (suspected arrhythmias, MI, pericarditis, pulmonary embolism);
 * laboratory examination – KO (leukocytosis, anemia, in chronic hypoxia relative polyglobulia), glycemia (diabetic coma);
 * pulmonary function - distinguishing restriction and obstruction + control of the development of the disease.