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A. Pulmonary

  1. Parenchymal Restriction (Infiltration, Interstitial Disease)
  2. Pulmonary Embolism
  3. Pulmonary Edema [1]
    1. Cardiogenic
    2. Non-cardiogenic (including adult respiratory distress syndrome, ARDS)
    3. B-type natriuretic peptide (BNP) and chest radiographs provide differential information [2]
    4. Plasma BNP <100pg/mL in emergency room patients with dyspnea carries ~90% likelihood that CHF is not present [3]
    5. NT-proBNP guided care reduced duration of emergency room visits in dyspnea patients [4]
  4. Pneumonia
  5. Asthma, Hyperactive Airways, Allergies
  6. Chronic obstructive pulmonary disease (COPD)
  7. Foreign Body
  8. Transfusion Related Acute Lung Injury (TRALI) [5]

B. Cardiovascular

  1. Congestive Heart Failure (CHF)
  2. Myocardial Infarction / Ischemia
  3. Valvular Insufficiency (especially Mitral Regurgitation)
  4. Anemia

C. Metabolic

  1. Anion Gap Acidosis
  2. Renal Tubular Acidosis

D. Neurogenic

  1. Pain
  2. Panic Disorder
    1. Agorophobia
    2. Associated with Mitral Valve Prolapse
  3. Anxiety Attack
  4. Phrenic Nerve Paralysis

E. Exertional Dyspnea (DOE)

  1. CHF
  2. Mitral Insufficiency
  3. Mitral Stenosis
  4. Pulmonary Valve Regurgitation
  5. Chronic Lung Disease
  6. Pulmonary Embolism
  7. Right to Left Shunt
  8. Cardiac Ischemia (also cardiac asthma)

References

  1. Mueller C, Scholer A, Laule-Kilan K, et al. 2004. NEJM. 350(7):647 abstract
  2. Knudson CW, Omland T, Clopton P, et al. 2004. Am J Med. 116(6):363 abstract
  3. Wang CS, FitzGerald JM, Schulzer M, et al. 2005. JAMA. 294(15):1944 abstract
  4. Moe GW, Howlett J, Januzzi JL, Zowall H. 2007. Circulation. 115:3103 abstract
  5. Kopko PM, Marshall CS, MacKenzie MR, et al. 2002. JAMA. 287(15):1968 abstract