![]() ![]() The magnitude of elevation is proportional to the severity of heart failure and the New York Heart Association functional classification. It is released in response to pressure/volume overload resulting in increased wall tension. Pleural effusion atelectasis pneumothoraxīrain natriuretic peptide (BNP), also known as B-type natriuretic peptide, is a neurohormone synthesized by ventricular myocytes that is useful in the diagnosis of heart failure. Localized, decreased, or absent breath sounds Hypersensitivity pneumonitis (bird fancier's lung)Īccentuated P 2 right ventricular heave murmursĪbnormal inspiratory or expiratory sounds heard best over the tracheaĬentral airway obstruction vocal cord paralysis laryngeal tumor tracheal stenosis Organic exposure to dust (birds, mushrooms) Pneumoconiosis silicosis berylliosis coal workers lung asbestosis Opportunistic infections: protozoal (Pneumocystis carinii pneumonia) bacterial (tuberculosis Legionella) viral (cytomegalovirus) or fungal (Aspergillus)Įxposure to inorganic dust, asbestos, or volatile chemicals History of immunosuppressive disease or therapy acquired immunodeficiency syndrome Lung neoplasm pneumonia bronchiectasis mitral stenosis arteriovenous malformationīeta blockers aggravating obstructive airway diseaseĪmiodarone (Cordarone)/nitrofurantoin (Furadantin): pneumonitis ![]() Gastroesophageal reflux disease aspiration food allergy History of generalized anxiety disorder, post-traumatic stress disorder, obsessive-compulsive disorder, panic disorder intermittent symptoms sighing breathing History of hypertension, coronary artery disease, or diabetes mellitus orthopnea paroxysmal nocturnal dyspnea pedal edema jugular vein distention S 3 gallop bibasilar rales wheezing Significant tobacco consumption barrel chest prolonged expiration wheezing Intermittent breathlessness triggering factors allergic rhinitis nasal polyps prolonged expiration wheezing These include ventilation perfusion scans, Holter monitoring, cardiac catheterization, esophageal pH monitoring, lung biopsy, and cardiopulmonary exercise testing. If the diagnosis remains unclear, additional tests may be required. Echocardiography and brain natriuretic peptide levels help establish a diagnosis of congestive heart failure. High-resolution computed tomography is particularly useful for diagnosing interstitial lung disease, idiopathic pulmonary fibrosis, bronchiectasis, or pulmonary embolism. Formal pulmonary function testing may be needed to establish a diagnosis of asthma, chronic obstructive pulmonary disease, or interstitial lung disease. If these are inconclusive, additional testing is indicated. The history and physical examination should guide selection of initial diagnostic tests such as electrocardiogram, chest radiograph, pulse oximetry, spirometry, complete blood count, and metabolic panel. Asthma, congestive heart failure, chronic obstructive pulmonary disease, pneumonia, cardiac ischemia, interstitial lung disease, and psychogenic causes account for 85 percent of patients with this principal symptom. Establishing an accurate diagnosis is essential because treatment differs depending on the underlying condition. In approximately two thirds of patients presenting with dyspnea, the underlying cause is cardiopulmonary disease. ![]() Chronic dyspnea is defined as dyspnea lasting more than one month. ![]()
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