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Dyspnea (Qns to ask (SR (Chest pain? (MI: Heaviness, pressure, or crushing…

- - - - Asthma, Ischemic heart disease
    - - Interstitial lung disease
    - - Deconditioning, Anemia, Pulmonary disease
    - - Panic disorder
  - - - Orthopnea/PND in CHF
    - - Trepopnea can occur with unilateral pleural effusion (on the recumbent side) or chronic heart failure (prefer lying on left side)
    - - Exercise induced asthma; symptoms begin after exercising for some time. Cardiomyopahty; symptoms begin after a short period of exercise
    - - Acute pneumonia (80% have fever), Acute PE (20%), Chronic pneumonia, Inflammatory interstitial lung disease
    - - Asthma: Non productive cough
      - Flash pulmonary edema: Cough with pink frothy sputum
      - PE: Non productive cough with occasional scant hemoptysis
      - GERD
      - Aspiration
      - Acute pneumonia
      - COPD: Chronic Bronchitis: 2 months of productive cough per year for 2 consecutive years
      - Interstitial lung disease
    - - Pericardial disease: Bilat edema with abdo swelling
      - Severe right heart failure due to chronic lung disease with pulmonary hypertension: Cor pulmonale: Bilat edema with abdo swelling
      - Cardiomyopathy: Bilat edema
      - DVT with PE: Unilateral leg edema
  - - - Nonadherence with CHF or COPD medication often lead to an exacerbation. Conversely, toxic overdoses may also occur.
      - Methotrexate (for rheum disease) and nitrofurantoin (for UTI) can cause interstitial lung disease
      - New medications(Beta lactam antibiotics, ACE inhibitor)
        
        Allergic reaction, angioedema
  - - - Past Hx of MI
      - Past Hx of coronary artery disease
      - Past hx of CHF
    - - Coronary artery disease,cardiomyopathy
    - - Premature coronary disease is sig when a first degree relative has had sig coronary artery heart disease before age 50 if male or age 60 if female
    - - Rheumatic diseases (eg RA,SLE,polymyositis) cause chronic interstitial lung disease. NM diseases may predispose the patient to aspiration or weaken respiratory muscles.Methotrexate (for rheumatologic disease) and nitrofurantoin (for UTI) can cause interstitial lung disease
  - - - COPD
      - Desquamative interstitial pneumonia
      - Coronary artery disease
      - Lung cancer
    - - PE
        
        Well's criteria
        
        Don't die tell team to check criteria
        
        Three days of immobilisation(at least),surgery in the past thirty days
        
        Thromboembolism in the past (DVT or PE)
        
        Tachycardia
        
        Coughing out blood (hemoptysis)
        
        Diagnosis most likely PE
        
        Cancer
        
        DVT
    - - Histoplasmosis, coccidioidomycosis, blastomycosis, tuberculosis
    - - Anaphylaxis (patients may know that they are allergic to insects, nuts, or shellfish but be unaware that recently ingested food contained these allergens.
  - - - Primary lung CA is the number one cause of cancer related mortality. Lung parenchyma and pleura are also common sites of metastasis. Chemotherapy can cause pulmonary fibrosis (bleomycin), heart failure(doxorubicin), and anemia. Radiation therapy to the chest can cause constrictive pericarditis and accelerated CAD. Heart disease may result in arrhythmias.
    - - MI: Heaviness, pressure, or crushing substernal pain radiating to the jaw or left arm
      - Spontaneous pneumothorax: Unilateral pleuritic pain
      - PE: Unilateral or bilateral pleuritic pain
      - Cardiac tamponade: Central chest heaviness
      - Pericarditis: Pleuritic pain radiating to back with positional improvement
    - - Anaphylaxis
    - - Primary or metastatic lung cancer
      - Chronic pneumonia
    - - Primary or secondary pulmonary hypertension
    - - ILD associated with systemic inflammatory conditions (eg sarcoidosis)
    - - Aspiration (stroke, GBS, MG, Amyotrophic lateral sclerosis)
- - - - Chest pain
        
        No
        
        Wheezing
        
        Yes
        
        Anaphylaxis
        
        Aspiration
        
        Asthma
        
        COPD exacerbation
        
        No
        
        Acidosis
        
        Respiratory muscle weakness
        
        Yes
        
        Pleuritis?
        
        No
        
        Pericardial effusion/Cardiac tamponade
        
        Myocardial Ischemia
        
        Yes
        
        Pulmonary embolism
        
        Pericarditis
        
        Spontaneous pneumothorax
- - - - Wheezing
        
        Yes
        
        Asthma
        
        COPD
        
        No
        
        ILD
        
        Chronic pneumonia
        
        Pleural effusion
        
        Malignancy
    - - Deconditioning
      - Anemia
      - Cardiomyopathy
      - Neuromuscular disease
      - Pulmonary hypertension