The relevant physical signs, and their significance, in patients with dyspnoea are:
Respiratory
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 entry |
Pneumothorax (+/- tension), Pleural effusion Collapse/Consolidation/Contusion |
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 |
Cardiovascular
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 |
General
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 | CO2Â retention |