Journal of General Internal Medicine

, Volume 8, Issue 7, pp 383–392

Discriminating causes of dyspnea through clinical examination

  • Cynthia D. Mulrow
  • Catherine R. Lucey
  • Lisa E. Farnett
Clinical Review

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Tobin MJ. Dyspnea. Pathophysiologic basis, clinical presentation and management. Arch Intern Med. 1990;150:1604–13.PubMedCrossRefGoogle Scholar
  2. 2.
    Schwartzstein RM, Manning HL, Weiss W, Fencl V, Weinberger SE. Dyspnea: a sensory experience [review]. Lung 1990;168:185–99.PubMedGoogle Scholar
  3. 3.
    Smith PL, Bleecker ER. Pulmonary problems. In: Baker LR (ed). Principles of Ambulatory Medicine. Baltimore: Williams & Wilkins, 1982;418–20.Google Scholar
  4. 4.
    Ingram RH, Braunwald E. Dyspnea and pulmonary edema. In: Petersdorf RG (ed). Harrison’s Principles of Internal Medicine. New York: McGraw-Hill, 1983;158–61.Google Scholar
  5. 5.
    Siefkin AD. Dyspnea in the elderly: cardiac or pulmonary? Geriatrics. 1985;40:63–73.PubMedGoogle Scholar
  6. 6.
    Altose MD. Assessment and management of breathlessness. Chest. 1985;88(suppl):77S-83S.PubMedGoogle Scholar
  7. 7.
    Gift AG, Plaut SM, Jacox A. Psychologic and physiologic factors related to dyspnea in subjects with chronic obstructive pulmonary disease. Heart Lung. 1986;15:595–601.PubMedGoogle Scholar
  8. 8.
    Kellner R, Sheffield BF. The one-week prevalence of symptoms in neurotic patients and normals. Am J Psychiatry. 1973;130:102–5.PubMedGoogle Scholar
  9. 9.
    Brody EM, Klenban MH. Physical and mental health symptoms of older people: who do they tell? J Am Geriatr Soc. 1981;29:442–9.PubMedGoogle Scholar
  10. 10.
    Dodge RR, Burrows B. The prevalence and incidence of asthma and asthma-like symptoms in a general population sample. Am Rev Respir Dis. 1980;122:567–75.PubMedGoogle Scholar
  11. 11.
    Krzyzanowski M, Camilli AE, Lebowitz MD. Relationships between pulmonary function and changes in chronic respiratory symptoms. Comparison of Tucson and Cracow longitudinal studies. Chest. 1990;98:62–70.PubMedGoogle Scholar
  12. 12.
    Vestbo J, Knudsen KM, Rasmussen FV. Should we continue using questionnaires on breathlessness in epidemiology surveys? Am Rev Respir Dis. 1988;137:1114–8.PubMedGoogle Scholar
  13. 13.
    Dalphin JC, Bildstein F, Pernet D, Dubiez A, Depierre A. Prevalence of chronic bronchitis and respiratory function in a group of dairy farmers in the French Doubs Province. Chest. 1989;95:1244–7.PubMedGoogle Scholar
  14. 14.
    Eriksson H, Caidahl K, Larsson B, et al. Cardiac and pulmonary causes of dyspnea—validation of a scoring test for clinical-epidemiological use: the study of men born in 1913. Eur Heart J. 1987;8:1007–14.PubMedGoogle Scholar
  15. 15.
    Di Pede C, Viege G, Quackenboss JJ, Boyer-Pfersdorf P, Lebowitz MD. Respiratory symptoms and risk factors in Arizona population sample of Anglo and Mexican-American whites. Chest. 1991;99:916–22.PubMedGoogle Scholar
  16. 16.
    Viege G, Paoletti P, Prediletto R, et al. Prevalence of respiratory symptoms in an unpolluted area of Northern Italy. Eur Respir J. 1989;1:311–8.Google Scholar
  17. 17.
    Hammond EC. Some preliminary findings on physical complaints from a prospective study of 1,064,004 men and women. Am J Public Health. 1964;54:11–23.Google Scholar
  18. 18.
    Samet JM, Schrag SD, Howard CA, Key CR, Pathak DR. Respiratory disease in a New Mexico population sample of Hispanic and non-Hispanic whites. Am Rev Respir Dis. 1982;125:152–7.PubMedGoogle Scholar
  19. 19.
    Huhti E, Ikkala J. A 10-year follow-up study of respiratory symptoms and ventilatory function in a middle-aged rural population. Eur J Respir Dis. 1980;61:33–45.Google Scholar
  20. 20.
    Higgins ITT. Respiratory symptoms, bronchitis, and ventilatory capacity in a random sample of an agricultural population. BMJ. 1957;2:1198–203.PubMedGoogle Scholar
  21. 21.
    Gulsvik A. Prevalence of respiratory symptoms in the City of Oslo. Scand J Respir Dis. 1979;60:275–85.PubMedGoogle Scholar
  22. 22.
    Ferris BG, Chen H, Puleo S, Murphy LH. Chronic nonspecific respiratory disease in Berlin, New Hampshire, 1967 to 1973. A further follow-up study. Am Rev Respir Dis. 1976;113:475–85.PubMedGoogle Scholar
  23. 23.
    Kroenke K, Mangelsdorff D. Common symptoms in ambulatory care; incidence, evaluation, therapy, and outcome. Am J Med. 1989;86:262–5.PubMedCrossRefGoogle Scholar
  24. 24.
    Fedullo AL, Swinburne AJ, McGuire-Dunn C. Complaints of breathlessness in the emergency department. The experience at a community hospital. N Y State J Med. 1986;86:4–6.PubMedGoogle Scholar
  25. 25.
    Pearson SB, Pearson EM, Mitchell JRA. How easy is it to diagnose and treat breathlessness? Lancet. 1980;2:1368.PubMedCrossRefGoogle Scholar
  26. 26.
    Pearson SB, Pearson EM, Mitchell JRA. The diagnosis and management of patients admitted to hospital with acute breathlessness. Postgrad Med J. 1981;57:419–24.PubMedGoogle Scholar
  27. 27.
    Mustchin CP, Tiwari I. Diagnosing the breathless patient. Lancet. 1982;2:907–8.CrossRefGoogle Scholar
  28. 28.
    Schmitt BP, Kushner MS, Wiener SL. The diagnostic usefulness of the history of the patient with dyspnea. J Gen Intern Med. 1986;1:386–93.PubMedCrossRefGoogle Scholar
  29. 29.
    Pratter MR, Curlwy FJ, Dubois J, Irwin R. Cause and evaluation of chronic dyspnea in a pulmonary disease clinic. Arch Intern Med. 1989;149:2277–82.PubMedCrossRefGoogle Scholar
  30. 30.
    Seller RH, Lobley M. Efficient diagnosis of common complaints: a comparative study in the United States and England. J Fam Pract. 1991;33:41–6.PubMedGoogle Scholar
  31. 31.
    Zema MJ, Masters AP, Margouleff D. Dyspnea: the heart or the lungs. Differentiation at bedside by use of the simple Valsalva maneuver. Chest. 1984;85:59–64.PubMedGoogle Scholar
  32. 32.
    Simon PM, Schwartzstein RM, Weiss JW, Fencl V, Teghtsoonian M, Weinberger SE. Distinguishable types of dyspnea in patients with shortness of breath. Am Rev Respir Dis. 1990;142:1009–14.PubMedGoogle Scholar
  33. 33.
    Elliott MW, Adams L, Cockcroft A, Macrae KD, Murphy K, Guz A. The language of breathlessness. Use of verbal descriptors by patients with cardiopulmonary disease. Am Rev Respir Dis. 1991;144:826–32.PubMedGoogle Scholar
  34. 34.
    Ard RW, Twinning RH. Evaluation of the Valsalva test in the bedside diagnosis of dyspnea. Am J Med Sci. 1957;3:403–12.Google Scholar
  35. 35.
    Marantz PR, Kaplan MC, Alderman MH. Clinical diagnosis of heart failure in patients with acute dyspnea. Chest. 1990;97:776–81.PubMedGoogle Scholar
  36. 36.
    Sackett DL, Haynes RB, Guyatt GH, Tugwell P. Clinical Epidemiology: A Basic Science for Clinical Medicine, 2nd ed. Boston: Little Brown, 1991.Google Scholar
  37. 37.
    Valsalva AM. De aura humana tractus. Utrecht: G Vande Water, 1707;84.Google Scholar
  38. 38.
    Derbes VJ, Kerr A Jr. Valsalva’s maneuver and Weber’s experiment. N Engl J Med. 1955;253:822–3.PubMedCrossRefGoogle Scholar
  39. 39.
    Mills H, Kattus AA. The emphysema response to forced straining (Valsalva’s maneuver). Circulation. 1958;17:65–71.PubMedGoogle Scholar
  40. 40.
    Sharpey-Schafey FP. Effects of Valsalva’s manoeuver on the normal and failing circulation. BMJ. 1955;1:693–5.CrossRefGoogle Scholar
  41. 41.
    Zema MJ, Restivo B, Sos T, Sniderman KW, Kline S. Left ventricular dysfunction-bedside Valsalva manoeuvre. Br Heart J. 1980;44:560–9.PubMedGoogle Scholar
  42. 42.
    Knowles JH, Gorlin R, Storey CF. Clinical test for pulmonary congestion with use of the Valsalva maneuver. JAMA. 1956;160:44.Google Scholar
  43. 43.
    Judson WE, Hatcher JD, Wilkins RW. Blood pressure responses to the Valsalva maneuver in cardiac patients with and without heart failure. Circulation. 1955;11:889.PubMedGoogle Scholar
  44. 44.
    Gorlin R, Knowles JH, Storey CF. The Valsalva maneuver as a test of cardiac function. Pathologic physiologic and clinical significance. Am J Med. 1957;197–212.Google Scholar
  45. 45.
    Zema MJ, Caccavano M, Kligfield P. Detection of left ventricular dysfunction in ambulatory subjects with the bedside Valsalva maneuver. Am J Med. 1983;75:241–8.PubMedCrossRefGoogle Scholar
  46. 46.
    Irvin CW. Valsalva maneuver as a diagnostic aid. JAMA. 1959;170:787–91.Google Scholar
  47. 47.
    Malmberg R, Albrecht G, Baltazaar A, Buckingham WB, Levine H, Cugell DW. The Valsalva maneuver as a test of cardiac function in patients with pulmonary disease. Am Rev Respir Dis. 1964;89:64–72.PubMedGoogle Scholar
  48. 48.
    Rondot E. Le reflux hepatojugulaire. Gazette Hebdomadaire des Sciences Medicales de Bordeaux. 1898;19:567–71.Google Scholar
  49. 49.
    Lian C, Blundel A. Reflux sign in heart insufficiency. Presse Med. 1925;33:481–2.Google Scholar
  50. 50.
    Ewy G. The abdominojugular test: technique and hemodynamic correlates. Ann Intern Med. 1988;109:456–60.PubMedGoogle Scholar
  51. 51.
    Matthews M, Hampson J. Hepatojugular reflux. Lancet. 1958;1:873–6.PubMedCrossRefGoogle Scholar
  52. 52.
    Ducas J, Magder S, McGregor M. Validity of the hepatojugular reflux as a clinical test for congestive heart failure. Am J Cardiol. 1983;52:1299–303.PubMedCrossRefGoogle Scholar
  53. 53.
    Harlan WR, Oberman A, Grimm R, Rosati RA. Chronic congestive heart failure in coronary artery disease: clinical criteria. Ann Intern Med. 1977;86:133–8.PubMedGoogle Scholar

Copyright information

© Society of General Internal Medicine 1993

Authors and Affiliations

  • Cynthia D. Mulrow
    • 1
  • Catherine R. Lucey
    • 2
  • Lisa E. Farnett
    • 3
    • 4
  1. 1.the Division of General Internal Medicine, Department of Medicinethe University of Texas Health Science Center at San AntonioSan Antonio
  2. 2.the Division of General Medicine, Department of MedicineWalter Reed Army Medical CenterTacoma
  3. 3.the College of Pharmacythe University of Texas at AustinAustin
  4. 4.the Geriatrics Research Education and Clinical Center at the Audie L. Murphy Memorial Veterans Hospital at San AntonioSan Antonio
  5. 5.Ambulatory Care (11C)Audie L. Murphy Memorial Veterans HospitalSan Antonio

Personalised recommendations