The Key Conditions Causing Dyspnoea
The key conditions that can cause dyspnoea and their associated symptoms and signs are:
Anaphylaxis
| Presenting symptoms | Physical signs |
| Abrupt onset Exposure to allergen Previous episodes Collapse | Upper airway obstruction: stridor Respiratory – expiratory wheeze, tachypnoea Cardiovascular collapse: tachycardia, hypotension Widespread rash |
Asthma
| Presenting symptoms | Physical signs |
| Known diagnosis Previous episodes Precipitating factors May have abrupt onset | Tachypnoea, tachycardia Accessory muscle use Diffuse expiratory wheeze Cyanosis, exhaustion |
Pneumonia
| Presenting symptoms | Physical signs |
| Progressive symptoms Systemic symptoms Fever May have associated chest pain Productive cough | Pyrexia Tachypnoea, tachycardia Coarse / focal crepitations Bronchial breath sounds Focally reduced breath sounds |
COPD
| Presenting symptoms | Physical signs |
| Known diagnosis Previous episodes Smoker Progressive symptoms Productive cough | Tachypnoea, tachycardia Accessory muscle use Diffuse expiratory wheeze Cyanosis, exhaustion |
Pneumothorax (simple)
| Presenting symptoms | Physical signs |
| Sudden onset Associated with pleuritic pain May have previous episodes | Tachypnoea, tachycardia Unilateral reduced breath sounds Hyperresonance to percussion |
Pneumothorax (tension)
| Presenting symptoms | Physical signs |
| As for simple pneumothorax plus:
| As for simple pneumothorax plus:
|
Pulmonary embolus
| Presenting symptoms | Physical signs |
| Abrupt onset Associated with pleuritic pain Risk factors for VTE | Tachypnoea May be associated with cardiovascular collapse Pleural friction rub |
Pulmonary oedema
| Presenting symptoms | Physical signs |
| Usually progressive May be abrupt in onset Previous episodes Previous myocardial infarction (MI) Risk factors for ischaemic heart disease (IHD) | Diaphoretic: clammy, cool, pale Dyspnoea, tachypnoea Elevated JVP if associated with CCF Bilateral inspiratory crepitations Gallop rhythm |
Cardiac tamponade
| Presenting symptoms | Physical signs |
| Abrupt onset Collapse | Tachypnoea, tachycardia Becks triad: raised JVP, shock, quiet heart sounds |
Pleural effusion
| Presenting symptoms | Physical signs |
| Gradual onset | Tachypnoea Localised dullness to percussion Reduced breath sounds and vocal sounds |
Anxiety
| Presenting symptoms | Physical signs |
| May have abrupt onset Previous episodes related to stress Tingling/pins and needles | Hyperventilation syndrome: tachypnoea, tachycardia, tetany No other abnormal physical findings |