Physical Signs of Dyspnoea

The relevant physical signs, and their significance, in patients with dyspnoea are:


Sign Significance
Tachyopnea Indicates respiratory distress (non-specific)
Associated with majority of causes of dyspnoea
Bradypnoea Very worrying sign indicating potential respiratory arrest
irregular respiratory pattern Intracranial event
Stridor Upper airways obstruction (e.g. anaphylaxis)
Asymmetrical chest
wall movement
Usually associated with injury / local tenderness
Pneumothorax (+/- tension), fractured ribs, flail segment
Subcutaneous emphysema Pneumothorax, rib fractures
Unilateral decreased air
Pneumothorax (+/- tension), Pleural effusion
Crepitations Inspiratory, fine: pulmonary oedema / fibrosis
Expiratory, coarse, may be focal: pneumonia
Wheeze Inspiratory/Monophonic: Focal bronchial obstruction. Expiratory/Polyphonic: COPD/Asthma
Bronchial breath sounds Consolidation – pneumonia
Friction rub Pleurisy, pulmonary embolus


Sign Significance
Tachycardia Indicates respiratory distress (non-specific)
Hypotension Serious underlying pathology including PE, tension pneumothorax, sepsis, cardiac tamponade
Elevated jugular venous pressure (JVP) Tension pneumothorax, cardiac tamponade, PE,
pulmonary hypertension, congestive cardiac failure (CCF)
Cardiac murmur Valvular abnormality
Added heart sounds S3/S4 gallop rhythm in cardiac failure
Massive PE with right ventricular failure


Sign Significance
Pyrexia Infection – pneumonia
Weight loss Malignancy
Clubbing Chronic respiratory conditions, congenital heart disease
Pallor Anaemia
Cyanosis Severe respiratory compromise, cyanotic heart disease
Muscle wasting Neuromuscular disease
Peripheral oedema Congestive cardiac failure
Calf tenderness Pulmonary embolism (PE)
Hand tremor/flap CO2 retention