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.

Links

References

• GESENHUES, S – ZIESCHÉ, R. Vademecum of the physician. 1. Czech edition. Prague : Galen, 2006. ISBN 80-7262-444-X.