Approach to Dyspnoea

Murtagh's diagnostic model 

Probability diagnosis 

• Bronchial asthma 
• Bronchiolitis 
• COPD 
• Lack of fitness
• Left heart failure
• Obesity 

Serious disorders not to be missed

• cardiovascular:
• acute heart failure (e.g. AMI)
• Arrhythmia 
• Pulmonary embolism 
• Pulmonary hypertension 
• Dissecting aneurysm 
• Cardiomyopathy
• Pericardial tamponade
• Anaphylaxis
• Neoplasia
• Bronchial carcinoma
• Severe infections
• SARS
• avian influenza
• penumonia 
• acute epiglottis (children)
• Respiratory disorders
• inhaled foreign body 
• upper airways obstruction 
• pneumothorax
• atelectasis 
• pleural effusion 
• tuberculosis 
• Acute respiratory distress syndrome
• infective polyneuritis
• poliomeylitis 

Pitfalls 

• Interstital lung disorder:
• fibrosing alveolitis
• extrinsic allergic alveolitis
• Sarcoidosis
• Chemical pneumonitis
• Metabolic acidosis 
• Radiotherapy 
• Kidney failure 
• Multiple smal pulmonary emboli