Fever
Deconditioning,
Pulmonary
Asthma
Chronic obstructive pulmonary disease
Infection: Pneumonia, Bronchitis, TB, Fungal infection.
Aspiration
Pulmonary embolus
Pneumothorax
Pulmonary hypertension
Pleural effusion
Interstitial fibrosis
Upper airway obstruction: epiglottitis, croup, Epstein-Barr virus
Foreign body aspiration
Granulomatosis with polyangiitis, (formerly called Wegener’s granulomatosis)
Acute respiratory distress syndrome (ARDS); Pulmonary edema.
Tumor; metastatic disease
hypercapnia,
Heart and CV
Heart failure
Myocardial infarction
Congestive heart failure; Cardiomyopathy
Valvular heart disease: Aortic insufficiency/stenosis, mitral valve insufficiency/stenosis
Congenital heart disease,
Arrhythmias e.g. SVTs
Restrictive: Cardiac tamponade; Constrictive pericarditis, pericardial effusion;
Myocarditis
Anemia, Methemoglobinemia
Shock; sepsis
Abdomen/GI
GERD with aspiration
Abdominal distension, obesity
Physiologic dyspnea during pregnancy
Psychogenic: Anxiety, Panic attack, pain, hyperventilation
Neurologic/Neuromuscular
Myasthenia gravis; Increased intracranial pressure; respiratory muscle weakness,
Central: neuromuscular disorders, pain, aspirin overdose
Endocrine/Metabolic: Metabolic acidosis; Hyperthyroidism
Drugs e.g aspirin
Neuroleptic malignant syndrome
Thinking through the differential diagnosis
As you work through the ddx, it’s helpful to think about Acute vs. Chronic causes.
Also, try to think about the causes anatomically: Pulmonary, Cardiac, G.I., Neurologic, Neuromuscular, Metabolic, etc. You may apply VINDICATED MEN to each major anatomic location to think out more differential cases.
Further Reading
Dtsch Arztebl Int. 2016 Dec; 113(49): 834–845. The Differential Diagnosis of Dyspnea. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5247680/
Am Fam Physician. 2012 Jul 15;86(2):173-180. Causes and Evaluation of Chronic Dyspnea.
Am Fam Physician. 2003 Nov 1;68(9):1803-1811. Acute Dyspnea in the Office
Am Fam Physician. 1998 Feb 15;57(4):711-716. Diagnostic Evaluation of Dyspnea. https://www.aafp.org/afp/1998/0215/p711.html