Der Internist
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In addition to cardiac and pulmonary diseases there is a broad variety of different underlying causes of dyspnea. The spectrum includes the different forms of anemia, all causes of upper airway obstructions, neuromuscular diseases and psychopathological disorders. This article gives a brief review of the entire spectrum by providing information about differential diagnostics as well as the main therapeutic principles. A field of growing interest is dyspnea in the context of palliative care.
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The diagnostic pathway for the evaluation of patients with dyspnea requires a thorough history taking and physical examination. Based on the results of these basic steps a broad variety of additional diagnostic tests are available. ⋯ Among these are electrocardiography (ECG), laboratory parameters, X-ray examination, echocardiography, spirometry and whole body plethysmography and finally spiroergometry. This article presents a focused review of what each of these diagnostic modalities can contribute to the diagnostic process for dyspnea.
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The subjective perception of pulmonary dyspnea varies based on behavioral and physiological responses. Acute pulmonary dyspnea is the most common symptom of diseases of the airways and the lungs and the differential diagnosis includes harmless causes, such as lack of training as well as acute life-threatening diseases, such as thromboembolism, obstruction of the upper or lower airway, pneumonia, pulmonary hemorrhage and pneumothorax. Most cases of chronic pulmonary dyspnea result from asthma, chronic obstructive pulmonary disease (COPD), pulmonary arterial hypertension, pulmonary fibrosis and pleural disorders. ⋯ Measurement of brain natriuretic peptide levels may help to exclude heart failure in COPD and D-dimer testing may help rule out pulmonary embolisms. Computed tomography of the chest is the most appropriate imaging procedure for diagnosing pulmonary embolism and interstitial lung disease. To diagnose pulmonary arterial hypertension echocardiography and right heart catheterization may be necessary.
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Randomized Controlled Trial
[Effects of glycemic index on cardiovascular risk factors: The OmniCarb randomized clinical trial].
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Dyspnea represents one of the most frequent and heterogeneous symptoms. The term dyspnea describes the subjective perception of an inadequate effort to breathe. In general, acute and chronic forms have to be differentiated. ⋯ The differential diagnosis needs a structured approach including anamnestic and medical technical methods, aiming an efficient differentiation of cardiac and pulmonary causes. As a high number of patients suffer from more than one significant disease, the differential diagnostic assessment needs to be focused on the assessment of the predominant cause of the dyspnea. For this purpose, exercise tests provide helpful algorithms to answer this question.