Chronic Dyspnea

CARDIAC

RESPIRATORY

 bold = common

SUMMARY APPROACH

1.  Address Myocardial Ischemia (Risk Factors; associated Anginal Equivalents)
  • If possible, order EKG & Stress Testing
2.  If Ischemia unlikely, base Dx on Lung Exam
  • Wheezes, Rhonchi, Long Expiratory Phase suggest Asthma
    • Give therapeutic trial
  • Bibasilar Rales suggest CHF
3.  If NOT asthma, or if therapeutic trial no help, order initial W/U:
  • CXR
  • CBC
  • BNP
  • Chemistries & TSH if can’t distinguish dyspnea from fatigue
4.  Still no diagnosis?  Order:
  • Echocardiogram
  • Pulmonary Function Testing

5.  Progressive deconditioning (i.e. being out of shape) is a diagnosis of exclusion.

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