Approach to the Patient: Dyspnea (Fig. 33-3) In obtaining a history, the patient should be asked to describe in his/her own words what the discomfort feels like, as well as the effect of position, infections, and environmental stimuli on the dyspnea. Orthopnea is a common indicator of congestive heart failure, mechanical impairment of the diaphragm associated with obesity, or asthma triggered by esophageal reflux. Nocturnal dyspnea suggests congestive heart failure or asthma. Acute, intermittent episodes of dyspnea are more likely to reflect episodes of myocardial ischemia, bronchospasm, or pulmonary embolism, while chronic persistent dyspnea is typical of COPD and. | Chapter 033. Dyspnea and Pulmonary Edema Part 4 Approach to the Patient Dyspnea Fig. 33-3 In obtaining a history the patient should be asked to describe in his her own words what the discomfort feels like as well as the effect of position infections and environmental stimuli on the dyspnea. Orthopnea is a common indicator of congestive heart failure mechanical impairment of the diaphragm associated with obesity or asthma triggered by esophageal reflux. Nocturnal dyspnea suggests congestive heart failure or asthma. Acute intermittent episodes of dyspnea are more likely to reflect episodes of myocardial ischemia bronchospasm or pulmonary embolism while chronic persistent dyspnea is typical of COPD and interstitial lung disease. Risk factors for occupational lung disease and for coronary artery disease should be solicited. Left atrial myxoma or hepatopulmonary syndrome should be considered when the patient complains of platypnea defined as dyspnea in the upright position with relief in the supine position. Figure 33-3 Algorithm for the Evaluation of the Patiemt with Dyspnea LHtÉite y Ovality cd sensaL-oo timing posit coal dsposibon PirSfaB M w. inwimiltM j Physical Exam Garnirai appearance Speak in hill lentencM Acowsory nufattf Cpior Viral Signs Tachypnea Ptilijs p i do us7 Quimelry-ev nge oi desal jiatb . C heat Wfaeart mine. itwoca dim - thod braalh toundtf Hypennluitep Cardiac axam jVP ievaW Pncorfllpl Gallops Mumtur EklremitltiS Ederr-n C boom At this pc- O. may wkfem 1 not. proceed to tort evaluation J Ch t rjckpgrflfh Assess cardiac size evidence ot CH AsSms far hypennftajipci far pneumpnip mier iiu H tu-ij pfayrpl tlfafont lew cardiac output. myuomSel seMtmu. or pj mpnaiy uasd j ji chsease Suspect respiraiory pump or gas e x change atxxxmalrty Suspect rngh car ac cuipul i I ECG end eclTKai dfDgurTi to assess e4l ventncular lunewM i and puiffxxwy artery pressure Pulmonary funchon testing d aHuSiig capacity reduced ccmuief CT angiogram asm far
