![]() ![]() Viral infection, malignancy, mycobacterial infection, chest radiation, inflammatory diseaseĬhest radiography, esophageal pH, esophagography Restrictive or constrictive pericardial disease Wheezing, lower extremity swelling, pleural rub, prominent P2, murmur, right ventricular heave, jugular venous distentionĭ-dimer, ventilation-perfusion scan, CT angiogram, echocardiography right heart catheterizationĮCG, event recorder, cardiac stress testing once stableĭyspnea on exertion, orthopnea, chest pain, prior coronary artery disease, atrial fibrillationĮdema, jugular venous distention, S3, displaced cardiac apical impulse, hepatojugular reflex, murmur, crackles, wheezing, tachycardia, S4ĮCG, brain natriuretic peptide, echocardiography, stress testing, coronary angiography ![]() Pleuritic chest pain, dyspnea not improved with supplemental oxygenĭecreased breath sounds, chest morphology, pleural rub, basal dullnessĬhest radiography, spirometry, pulmonary function testįatigue, pleuritic chest pain, prior emboli/deep venous thrombosis, thrombosis, syncope Peak flow, spirometry, chest radiography (hyperinflation), pulmonary function test Wheezing, barrel chest, decreased breath sounds, accessory muscle use, clubbing, paradoxical pulse Tobacco use, cough, relief with bronchodilators, increased sputum production, weight loss Hypoxia, clubbing, persistent inspiratory cracklesĬhest radiography (fibrosis interstitial markings), chest CT, bronchoscopy, biopsy Single randomized clinical trial showing no reduction in mortality or hospitalizationįever, productive cough, shortness of breathįever, productive cough, fremitus, bronchophonyĬhest radiography, chest CT, workup for bacterial and fungal organisms and noninfectious causesĮxertional dyspnea, dry cough, malignancy, drugs/medications, chemical exposure ![]() Supplemental oxygen has not been shown to reduce death or hospitalization in stable patients with chronic obstructive pulmonary disease and moderate hypoxia. High-resolution noncontrast computed tomography of the chest should be performed if the diagnosis of dyspnea is unclear and pulmonary etiology is suspected. Initial testing with chest radiography and then spirometry should be performed when a pulmonary cause is suspected. 16, 18, 22, 26, 28, 29Ĭlinical reviews and a small disease-oriented prospective study Observational studies and disease-oriented study evaluating lung functionĮlectrocardiography, brain natriuretic peptide, and cardiac ultrasonography should be obtained if heart failure is suspected. Smoking history and exposure should be assessed, and cessation should be encouraged regardless of duration of use. ![]() Care of patients with chronic dyspnea typically requires a multidisciplinary approach, which makes the primary care physician ideal for management. The six-minute walk test can be helpful in measuring the effect of ongoing intervention. There are three main treatment and management goals: correctly identify the underlying disease process and treat appropriately, optimize recovery, and improve the dyspnea symptoms. Final options include more invasive tests that should be done in collaboration with specialty help. If no cause is identified, second-line noninvasive testing such as echocardiography, cardiac stress tests, pulmonary function tests, and computed tomography scan of the lungs is suggested. Approaching testing in stages beginning with first-line tests, including a complete blood count, basic chemistry panel, electrocardiography, chest radiography, spirometry, and pulse oximetry, is recommended. A detailed history and physical examination should begin the workup results should drive testing. The likeliest causes of dyspnea are disease states involving the cardiac or pulmonary systems such as asthma, chronic obstructive pulmonary disease, heart failure, pneumonia, and coronary artery disease. As a symptom, dyspnea is a predictor for all-cause mortality. It is considered chronic if present for more than one month. Dyspnea is a symptom arising from a complex interplay of diseases and physiologic states and is commonly encountered in primary care. ![]()
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