Causes of Dyspnea (Shortness of Breath)

(Dyspnea actually is a shortness of breath in medical term.)

Dyspnea (Breathlessness) is a non-specific symptom and may be caused by cardiac, respiratory, neuromuscular and metabolic conditions, or by toxins or anxiety.

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Dyspnea may be caused by myocardial ischaemia and is known as ‘angina equivalent’. It may occur instead of, or with, chest discomfort, especially in elderly and diabetic patients. It has identical precipitants to angina and may be relieved by GTN.

Dyspnea in heart failure may be associated with fatigue. Pulmonary oedema (accumulation of fluid in the alveoli) occurs with left heart failure because increased left atrial enddiastolic pressure leads to elevated pressure in the pulmonary veins and capillaries.

Causes of Dyspnea:

Causes of dyspnea include:
Non-cardiorespiratory Causes
Anaemia
Metabolic acidosis
Obesity
Psychogenic
Neurogenic

Cardiac Causes

Left ventricular failure
Mitral valve disease
Cardiomyopathy
Constrictive pericarditis
Pericardial effusion

Respiratory System

Airways
Laryngeal tumour
Foreign body
Asthma
COPD
Bronchiectasis
Lung cancer
Bronchiolitis
Cystic fibrosis

Parenchyma

Pulmonary fibrosis
Alveolitis
Sarcoidosis
Tuberculosis
Pneumonia
Diffuse infections, e.g.Pneumocystis jirovecipneumonia
Tumour (metastatic, lymphangitis)

Pulmonary circulation

Pulmonary thromboembolism
Pulmonary vasculitis
Primary pulmonary hypertension

Pleural

Pneumothorax
Effusion
Diffuse pleural fibrosis

Chest wall

Kyphoscoliosis
Ankylosing spondylitis

Neuromuscular

Myasthenia gravis
Neuropathies
Muscular dystrophies
Guillain–Barré syndrome

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Types of Dyspnea:

• Paroxysmal nocturnal dyspnea is sudden breathlessness waking the patient from sleep. It is caused by accumulation of alveolar fluid.
• Orthopnoea is dyspnea on lying flat and is a sign of advanced heart failure. Lying flat increases venous return and in patients with left ventricular impairment may precipitate pulmonary oedema. The severity can be graded by the number of pillows used at night, e.g. ‘three-pillow orthopnoea’.
• Platypnoea is breathlessness on sitting upright. It is much rarer than orthopnoea and is usually associated with deoxygenation (platypnoea–orthodeoxia syndrome). It requires both anatomical and functional abnormalities.

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