TOC  | D-Dx    

Differential Diagnosis of Dyspnea - Shortness of Breath                               REF: Outlines in Clinical Medicine 2007
   A. Pulmonary |  B. Cardiovascular |  C. Metabolic  |  D. Neurogenic  |  E. Exertional Dyspnea  
A. Pulmonary

1. Parenchymal Restriction (Infiltration, Interstitial Disease)

2. Pulmonary Embolism

3. Pulmonary Edema

  • a. Cardiogenic
  • b. Non-cardiogenic (including adult respiratory distress syndrome, ARDS)
  • c. B-type natriuretic peptide (BNP) and chest radiographs provide differential information
  • d. Plasma BNP <100pg/mL in emergency room patients with dyspnea carries ~90% likelihood that CHF is not present

4. Pneumonia

5. Pleural Effusion of different etiologies

6. Asthma, Hyperactive Airways (Bronchospasm of different etiologies), Allergies

7. Chronic obstructive pulmonary disease (COPD)

8. Foreign Body

9. Transfusion Related Acute Lung Injury (TRALI)

   A. Pulmonary |  B. Cardiovascular |  C. Metabolic  |  D. Neurogenic  |  E. Exertional Dyspnea  
B. Cardiovascular

1. Congestive Heart Failure (CHF)

2. Myocardial Infarction / Ischemia

3. Valvular Insufficiency (especially Mitral Regurgitation)

4. Anemia

   A. Pulmonary |  B. Cardiovascular |  C. Metabolic  |  D. Neurogenic  |  E. Exertional Dyspnea     
C. Metabolic

1. Anion Gap Acidosis

2. Renal Tubular Acidosis

   A. Pulmonary |  B. Cardiovascular |  C. Metabolic  |  D. Neurogenic  |  E. Exertional Dyspnea      
D. Neurogenic

1. Pain

2. Panic Disorder:  a. Agorophobia   b. Associated with Mitral Valve Prolapse

3. Anxiety Attack

4. Phrenic Nerve Paralysis

   A. Pulmonary |  B. Cardiovascular |  C. Metabolic  |  D. Neurogenic  |  E. Exertional Dyspnea      
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)

   A. Pulmonary |  B. Cardiovascular |  C. Metabolic  |  D. Neurogenic  |  E. Exertional Dyspnea      

       2007