Breathlessness

• Acute Coronary Syndrome: Sudden onset, may be associated with chest pain, nausea, sweating.
• Heart Failure: Orthopnoea, paroxysmal nocturnal dyspnoea, peripheral oedema.
• Arrhythmias: Palpitations, syncope or pre-syncope, irregular pulse.
• Valvular Heart Disease: Murmurs, history of rheumatic fever, syncope.

• Asthma: Episodic, worse at night or early morning, wheeze.
• Chronic Obstructive Pulmonary Disease (COPD): Chronic cough, sputum production, smoking history.
• Pneumonia: Productive cough, fever, pleuritic chest pain.
• Pulmonary Embolism: Sudden onset, pleuritic chest pain, risk factors for DVT.
• Pneumothorax: Sudden onset, pleuritic chest pain, hyperresonance on affected side.

• Anaemia: Fatigue, pallor, history of chronic blood loss or poor dietary intake.
• Metabolic Acidosis: Kussmaul breathing, history of diabetes or chronic kidney disease.
• Thyrotoxicosis: Heat intolerance, weight loss, tremor, goitre.

• Anxiety Disorders: Hyperventilation, tingling in fingers and around mouth, history of panic attacks.
• Panic Attacks: Sudden onset, associated with fear, palpitations, sweating.

• Sudden onset: Suggests acute conditions like pulmonary embolism, pneumothorax, or acute coronary syndrome.
• Gradual onset: May point towards chronic conditions such as heart failure, COPD, or anaemia.

Characterising breathlessness (e.g., exertional, orthopnoea, paroxysmal nocturnal dyspnoea) and associated symptoms (e.g., chest pain, cough, palpitations, wheeze) can narrow down differentials.

• Relevant past medical history: Includes heart disease, respiratory disease, and systemic conditions like diabetes or thyroid disease.
• Drug history: Should consider medications that may affect respiratory or cardiac function (e.g., beta-blockers, amiodarone).
• Family history: Can be relevant in conditions like cardiomyopathy or genetic anaemias.
• Social history: Including smoking, occupational exposure, and substance use, can provide important clues.

Include pulse oximetry, respiratory rate, heart rate, blood pressure, and temperature to assess the severity and potential cause of breathlessness.

• Full Blood Count: Check for anaemia, infection.
• Urea and Electrolytes: Assess renal function, electrolyte imbalance.
• BNP: Useful in assessing heart failure.
• D-dimer: If pulmonary embolism is suspected.
• Arterial Blood Gas: To assess for hypoxia, hypercapnia, acidosis.

• Chest X-ray: First-line imaging to assess for pneumonia, heart failure, pneumothorax, or masses.
• CT Pulmonary Angiography: Gold standard for diagnosing pulmonary embolism.
• Echocardiography: Assess cardiac function and valvular disease.
• Pulmonary Function Tests: Useful in diagnosing asthma, COPD, restrictive lung diseases.