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:

  • Collapse
  • Extreme respiratory distress

As for simple pneumothorax plus:

  • Tracheal deviation
  • Elevated JVP
  • Cardiovascular collapse: tachycardia, hypotension
  • trachea remains midline

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