Knowledge - Students should be able to describe
- What is meant by the term "dyspnea" and how patients describe this
sense of shortness of breath.
- The different patterns of dyspnea: exertional and positional (those not directly
related to exertion), i.e., paroxysmal nocturnal dyspnea, orthopnea.
- The basic mechanisms of dyspnea:
- cardiac: high cardiac output (anemia, hyperthyroidism, intracardiac shunt) normal
cardiac output (obesity, deconditioning) low cardiac output (left ventricular dysfunction,
pericardial disease, valvular disease)
- pulmonary: disorders of ventilatory control (ASA toxicity, dyspnea of pregnancy,
hyperventilation syndrome) derangements of the ventilatory pump (disorders of the ribcage,
vertebral bodies, muscles and pleura) gas exchange abnormalities (pneumonia, emphysema,
interstitial fibrosis, pulmonary embolus)
- Risk factors for the various causes of dyspnea especially cardiovascular and
Skills - Students should be able to:
- History-taking: obtain, document and present a medical history that
differentiates among the various causes of dyspnea.
- Physical examination: perform a physical exam to establish the diagnosis of a
patient with dyspnea.
- Differential Diagnosis: generate a differential diagnosis that recognizes
specific history and physical exam findings that distinguish:
- potentially life-threatening from trivial or less serious causes of dyspnea
- chronic from acute dyspnea and list specific/common causes of each
- cardiac from pulmonary dyspnea
- Laboratory: order and interpret diagnostic and lab tests based on the
Attitudes and Professional Behaviors:
- Ingram L, Braunwald E, Dyspnea, Chapter 32, in Harrison=s Principles of Internal
Medicine, 14th ed. Fauci AS, et al eds. 1998, McGraw-Hill, New York, pp 190-193.