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exertional dyspnea; dyspnea on exertion (DOE)
Also see dyspnea.
Etiology:
- heart disease
- myocardial ischemia
- bradyarrhythmias
- heart failure due to cardiomyopathy
- valvular heart disease
- acute myocarditis
- pericarditis
- pulmonary disease
- chronic obstructive pulmonary disease
- reactive airway disease
- interstitial lung disease
- pulmonary embolism (presentation may be acute) 32% [3]
- pulmonary sarcoidosis
- systemic disorders
- anemia
- hyperthyroidism
- aortic dissection (acute presentation)
Clinical manifestations:
- onset may be subtle & slowly progressive with insidious reduction of activities
- chest discomfort may accompany dyspnea
Laboratory:
- Hgb/Hct
- serum TSH
- markers of myocardial infarction (serum troponin-I) if acute
- pulse oximetry (SaO2)
- D-dimer if pulmonary embolism suspected
- serum BNP useful for distinguishing cardiac from pulmonary causes of dyspnea [1]
Special laboratory:
- electrocardiogram
- echocardiogram
- spirometry
- cardiopulmonary exercise stress testing
Radiology:
- chest X-ray
- pulmonary angiography vs ventilation-perfusion scan if pulmonary embolism suspected
General
dyspnea (shortness of breath {SOB})
References
- Medical Knowledge Self Assessment Program (MKSAP) 16, 19
American College of Physicians, Philadelphia 2012, 2021
- Medical Knowledge Self Assessment Program (MKSAP) 20
American College of Physicians, Philadelphia 2025
- Jani SM, Nallamothu BK, Cooper LT, Smith A, Fazel R.
Beating, Fast and Slow.
N Engl J Med 2017; 377:72-78. July 6, 2017
PMID: 28679100
http://www.nejm.org/doi/full/10.1056/NEJMcps1608688
- Prandoni P, Lensing AWA, Prins MH et al.
Prevalence of pulmonary embolism among patients with recent onset of dyspnea
on exertion. A cross-sectional study.
J Thromb Haemost 2023 Jan; 21:68-75.
PMID: 36695397
https://www.jthjournal.org/article/S1538-7836(22)07202-6/fulltext