Differential Diagnosis Dyspnea is the consequence of deviations from normal function in the cardiopulmonary systems. Alterations in the respiratory system can be considered in the context of the controller (stimulation of breathing); the ventilatory pump (the bones and muscles that form the chest wall, the airways, and the pleura); and the gas exchanger (the alveoli, pulmonary vasculature, and surrounding lung parenchyma). Similarly, alterations in the cardiovascular system can be grouped into three categories: conditions associated with high, normal, and low cardiac output (Fig. 33-2). Figure 33-2 Respiratory System Dyspnea Controller Acute hypoxemia and hypercapnia are associated with increased activity in the controller. . | Chapter 033. Dyspnea and Pulmonary Edema Part 3 Differential Diagnosis Dyspnea is the consequence of deviations from normal function in the cardiopulmonary systems. Alterations in the respiratory system can be considered in the context of the controller stimulation of breathing the ventilatory pump the bones and muscles that form the chest wall the airways and the pleura and the gas exchanger the alveoli pulmonary vasculature and surrounding lung parenchyma . Similarly alterations in the cardiovascular system can be grouped into three categories conditions associated with high normal and low cardiac output Fig. 33-2 . Figure 33-2 Respiratory System Dyspnea Controller Acute hypoxemia and hypercapnia are associated with increased activity in the controller. Stimulation of pulmonary receptors as occurs in acute bronchospasm interstitial edema and pulmonary embolism also leads to hyperventilation and air hunger as well as a sense of chest tightness in the case of asthma. High altitude high progesterone states such as pregnancy and drugs such as aspirin stimulate the controller and can cause dyspnea even when the respiratory system is normal. Ventilatory Pump Disorders of the airways . asthma emphysema chronic bronchitis bronchiectasis lead to increased airway resistance and work of breathing. Hyperinflation further increases the work of breathing and can produce a sense of an inability to get a deep breath. Conditions that stiffen the chest wall such as kyphoscoliosis or that weaken ventilatory muscles such as myasthenia gravis or the Guillain-Barré syndrome are also associated with an increased effort to breathe. Large pleural effusions may contribute to dyspnea both by increasing the work of breathing and by stimulating pulmonary receptors if there is associated atelectasis. Gas Exchanger Pneumonia pulmonary edema and aspiration all interfere with gas exchange. Pulmonary vascular and interstitial lung disease and pulmonary vascular congestion may produce dyspnea .
