DSA Approach to Dyspnea

Question 1

Where does the sensation of dyspnea originate?

Answer 1

• cerebral cortex as it receives sensory input from the afferents of the respiratory muscles and lungs - two main mechanisms leading to the sensation of dyspnea are impaired ventilatory mechanics and an increase in respiratory drive

Question 2

What can cause impaired ventilatory mechanics?

Answer 2

airflow obstruction, muscle weakness, or decreased chest wall compliance

Question 3

What can cause impaired respiratory drive?

Answer 3

parenchymal or pulmonary vascular lung disease, congestive heart failure, chemoreceptor stimulation, impaired gas exchange, pregnancy, and behavioral factors

Question 4

Patients with significant ___, accessory ___, or ____ dyspnea should be transferred to an acute care setting for evaluation.

Answer 4

Patients with significant tachypnea, accessory muscle use, or conversational dyspnea should be transferred to an acute care setting for evaluation.

Question 5

What is the DDX of acute dyspnea?

Answer 5

a. Cardiovascular causes are related to acute decreases in left ventricular function, or any event that increases pulmonary capillary pressure b. Respiratory causes are related to airway dysfunction, disruption of gas exchange by parenchymal disease, vascular disease, or disturbance of the ventilatory pump c. Panic disorder and hyperventilation syndrome should be considered diagnoses of exclusion

Question 6

What is the primary diagnostic tool of dyspnea?

Answer 6

CXR

Question 7

When does acute dyspnea become chronic?

Answer 7

when sx persist for longer than 1 month

Question 8

What are the most common causes of chronic dyspnea?

Answer 8

COPD, asthma, interstitial lung disease, or heart failure *Less common causes include pulmonary vascular disorders, valvular and pericardial heart disease, anemia, and thyroid disease.

Question 9

If a patient describes their dyspnea as chest tightness, they probably have? air hunger or suffocating?

Answer 9

a. asthma b. chronic HF

Question 10

Dry crackles on lung examination can signify the presence of ____.

Answer 10

pulmonary parenchymal disease

Question 11

In patients whose history exam and initial workup are unrevealing, what type of testings should be done?

Answer 11

cardiopulmonary exercise testing

Question 12

MRC Dyspnea Scale: Grade 1-5

Answer 12