Cardiac or pulmonary dyspnea in patients admitted to the emergency department

Abstract

A simple and quick way of discrimination between cardiac and pulmonary causes of dyspnea is essential in patients admitted to the emergency department. We aimed to assess the utility of easily applicable diagnostic tools in the differential diagnosis of cardiac and pulmonary causes of dyspnea in patients presenting with shortness of breath. Clinical and radiologic evaluation, peak expiratory flow (PEF), PaO2, PaCO2 measurements were performed in 94 patients admitted to the emergency room with dyspnea. All the patients were hospitalized for accurate diagnosis and later were categorized into cardiac and pulmonary dyspnea groups. PEF, %PEF (percent of predicted PEF), dyspnea differentiation index (DDI = PEF x PaO2/1000), %DDI (%PEF x PaO2/1000), PaO2 and PaCO2 measurements were compared between the two groups. When cardiac and pulmonary dyspnea groups were compared, considering 1.6 as the cut-off value for DDI, measurements above this value imply cardiac pathology with 76.7% sensitivity and 67.2% specificity. The sensitivity and specificity for cardiac dyspnea calculated according to the cut-off values were 96.7% and 40.6% for %DDI; 86.7% and 60.9% for PEF; 86.7% and 54.7% for %PEF; 66.7 and 68.7 for PaO2. Also for pulmonary dyspnea, sensitivity and specificity values for PaCO2 were 50% and 93%. We conclude that DDI, %DDI, PEF, %PEF, PaO2 and PaCO2 are simple and easily applicable tools for differential diagnosis of cardiac and pulmonary dyspnea. Adjunctive utility of these tests in the emergency department with clinical and radiologic evaluation contributes to this discrimination.

How frequently are physiological variables recorded in the emergency room in patients with obstructive pulmonary diseases and pneumonia?

“…23 Moreover, in order to distinguish between cardiac and pulmonary dyspnoea, measurements of PEF, P aO2, PaCO2 and indices of these variables are necessary tools in the ER. 24 The percentage of OPD patients who had arterial blood gas concentrations measured in our study (84%) is considerably higher than the recording rate of 64% in 70,000 patients admitted to hospital with acute exacerbations of COPD in the USA. 25 Several papers 26,27 indicate that physicians often fail to use spirometry for routine monitoring of asthma and COPD.…”

Moderating Effect of Psychosocial Factors for Dyspnea in Taiwanese and American Heart Failure Patients

“…Symptoms of dyspnea result from complex interactions between signals from the central nervous system and receptors in the upper airway, lungs, and chest wall (Carrieri-Kohlman, Lindsey, & West, 2003;Mahler & O'Donnell, 2005). Most conditions that cause dyspnea probably do so by more than one mechanism, and different conditions may share common mechanisms (American Thoracic Society, 1999;Malas et al, 2003). Dyspnea is thought be related to a variety of factors such as the clinical characteristics of the condition and, possibly, to psychosocial factors specific to the individual patient.…”

Assessment of Dyspnea in Acute Decompensated Heart Failure

“…Three studies have evaluated the use of PEFR for the diagnosis of patients with AHF (11)(12)(13). All found that patients with AHF could be readily distinguished from those with chronic lung disease by PEFR; however, its value for the diagnosis of heart failure (HF) is limited.…”

“…Three measurements were completed at each time point, with the highest PEFR recorded in l/min (11)(12)(13). Other data captured simultaneously included respiratory rate in breaths/min, oxygen saturation (%), and liters of oxygen delivered (in l/min).…”

“…Sample sizes were estimated from 3 prior studies of dyspneic patients with cardiovascular disease that showed baseline PEFRs of 224 l/min (SD: 82 l/min) (12), 253 l/min (SD: 93 l/min) (13), and 267 l/min (SD: 97 l/min) (11), and 1 study of patients with an acute exacerbation of chronic obstructive pulmonary disease (COPD), which had a mean PEFR of 113 l/min (SD: 51 l/min) (14). An improvement in the PEFR between 10 to 25 l/min, or approximately 5% to 12%, was considered clinically significant based on asthma studies (15,16).…”