Dyspnoea - pathophysiological basis

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Dyspnoea (shortness of breath) is a very common subjective sign of many illnesses. The patient describes it either as a feeling of lack of air or difficulty and labored breathing.

Shortness of breath is a subjective feeling of lack of air.

Causes

File:Overview of causes of shortness of breath.png

Simplified diff dg of dyspnea used in video

Pulmonary edema

Lobar pneumonia

The causes of shortness of breath are divided into:

• pulmonary – CHOPN, asthma, inflammatory lung diseases (pneumonia), interstitial lung processes (pneumonitis, pulmonary fibrosis due to pneumoconiosis or other diseases)
• pulmonary circulation disease with the development of pulmonary arterial hypertension (primary pulmonary hypertension or a consequence of pulmonary embolism),
• cardiac – heart failure with congestion in the pulmonary circulation and development of pulmonary edema – left-sided heart failure, or mitral stenosis (processes associated with increased pressure in the left atrium),
• psychogenic – hysteria, hyperventilatory tetany,
• neuromuscular – neurodegenerative muscle diseases, myasthenia, trauma,
• hematological – anemia
• metabolic longer-lasting respiratory compensation (Kussmaul breathing in decompensation of diabetic ketoacidosis)

Note: If the patient reports a recent chest injury, we must primarily think of pneumothorax or hemothorax.

Types

To assess shortness of breath, it is very important to distinguish whether it is exertional or rest. Resting shortness of breath usually indicates a greater degree of impairment. We further distinguish between inspiratory shortness of breath (difficulty inhaling, e.g. in pneumonia), or expiratory (difficulty, usually slow exhalation, e.g. in asthma). Depending on the nature and development of the problem, we can distinguish several different types of shortness of breath.

Sudden dyspnoea	Dysthrowing over hours, days
pneumothorax	COPD exacerbation, asthma bronchiale, fibrosis (IPF)
aspiration of foreign body	left-sided heart failure
pulmonary embolism	pneumonia, pleural effusion

Rapidly progressive dyspnea (acute dyspnea)

This form of dyspnea can occur suddenly, e.g. after aspiration (of a foreign body, stomach contents), or after trauma (development of pneumothorax. Similarly, acute dyspnea includes problems that develop over a period of days. These can be a symptom of severe pulmonary embolism, massive pulmonary edema (e.g. acute mountain sickness) and, last but not least, acute coronary syndrome (acute myocardial infarction, unstable angina pectoris), exacerbation of asthma.

Differential diagnosis of acute dyspnea
symptoms	probable cause of dyspnea
dyspnea and chest pain	ACS, PE, aortic dissection, pneumothorax, pleurisy
prolonged expiration, cough	left-sided heart failure, bronchial asthma, exacerbation of COPD
stridor	obstruction of upper respiratory tract, foreign body aspiration
cough and fever	pneumonia, acute bronchitis
cough without fever	pneumothorax, foreign body aspiration
silent lung, isolated spastic phenomena	status asthmaticus
general condition without alteration, paresthesia of extremities	hyperventilation
dyspnea without pathological lung findings	anemia, PE, pulmonary hypertension, intoxication, psychogenic dyspnea, ascites, metabolic acidosis, diabetic coma, uremia, musculoskeletal etiology. e.g.: Guillain-Barré syndrome, Myasthenia gravis

Long-lasting slowly progressive shortness of breath (chronic dyspnea)

It is typical of COPD, chronic pulmonary fibrotic diseases and heart failure. The patient describes the problems as long-term, gradually worsening, especially in relation to strenuous activities.

Orthopneic Dyspnea

In orthopneic dyspnea, the patient will find relief in the so-called orthopneic position. Sitting with a slight forward bend causes reduction of venous return and allows more effective use of the accessory respiratory muscles, thereby improving the overall mechanics of ventilation.

Paroxysmal nocturnal dyspnea

It typically occurs in cardiac patients, so-called cardiac asthma, and can accompany the initial stages of left ventricular failure in particular. The patient wakes up at night with the urge to sit up, reports "inability to breathe", shortness of breath and a feeling of "stale air in the room".

NYHA classification of dyspnea

The NYHA (ew York Heart Association) classification of dyspnea is currently the most widely used. It is primarily intended for the classification of dyspnea in heart failure, but is also commonly used to assess dyspnea of ​​other etiologies.

NYHA classification of dyspnea
! Class definition	Activity limitation
NYHA I	Only unable to perform higher exertion, faster running.	No limitation in daily life.
NYHA II	Only able to perform faster walking, not running.	Minor limitation in daily life.
NYHA III	Only basic household activities, walking 4 km/h. Even normal activity is exhausting.	Significant limitation of activity even at home.
NYHA IV	Dyspnea with minimal exertion even at rest. Necessary assistance from another person.	Major limitation in daily life.

Links

Related Articles

• Choking
• Cough
• Hemoptysis

Literature

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External links

Dyspnoea by Decoiled by Coiled 2023 (... dyspnea = shortness of breath, tachypnea, tachycardia, cyanosis, deoxyhemoglobin = reduced hemoglobin, central and peripheral cyanosis, disorientation, delirium, Astrup, blood gases, partial pressure O2, partial talc CO2, dissociation curve, ph arterailni blood, Horovitz index = P/F ratio, fractional oxygen ratio in inspired air)

Diagram used in the video 7 Causes of Shortness of Breath

The DrABC.cz channel video offers a way to better remember the 7 basic causes and their listening phenomena