Dyspnea Evaluation

Dyspnea is defined as an uncomfortable awareness of breathing. It is a subjective experience involving many factors that modulate the quality and intensity of its perception. Patients with comparable degrees of functional lung impairment and disease burden may describe varying intensities of dyspnea. Patients use a host of different words and phrases to describe the sensation of breathlessness. Terms such as tightness and suffocating are sometimes used.

Diagnostic Examination

Many diagnostic modalities used to evaluate dyspnea can be performed in the family physician's office. The basic evaluation is directed by the probable causes suggested in the history and physical examination. The most common organic causes of dyspnea are cardiac and pulmonary disorders.

The most useful methods of evaluating dyspnea are the electrocardiogram and chest radiographs. These initial modalities are inexpensive, safe and easily accomplished. They can help confirm or exclude many common diagnoses.

The electrocardiogram can show abnormalities of the heart rate and rhythm, or evidence of ischemia, injury or infarction. Voltage abnormality suggests left or right ventricular hypertrophy if the voltage is excessive, or pericardial effusion or obstructive lung disease with increased chest diameter if the voltage is diminished.

A chest radiograph can identify skeletal abnormalities, such as scoliosis, osteoporosis or fractures, or parenchymal abnormalities, such as hyperinflation, mass lesions, infiltrates, atelectasis, pleural effusion or pneumothorax. An increased cardiac silhouette can be caused by increased pericardial size or increased chamber size.

A finger-stick hemoglobin determination or a complete blood count can quantify the severity of suspected anemia. Thyroid abnormalities rarely present with dyspnea and can be assessed by measurement of the serum thyroid-stimulating hormone level.4,8

The history, physical examination and preliminary diagnostic modalities such as chest radiography and electrocardiography usually reveal the underlying cause or causes of dyspnea, but in selected cases further diagnostic evaluation may be needed. Useful second-line tests include spirometry, pulse oximetry and exercise treadmill testing. These tests can clarify the diagnosis if initial modalities indicate an abnormality or are inconclusive.

Source: WebMD
Source: American Family Physician