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Plötzliche Dyspnoe

Ein Beitrag zur Differenzialdiagnose

Acute dyspnea

A contribution to differential diagnosis

  • Leitthema
  • Published:
Der Pneumologe Aims and scope

Zusammenfassung

Die plötzliche Dyspnoe ist ein bedrohliches Symptom und geht häufig mit einer Angstreaktion einher. Durch die Befragung des Betroffenen und die Erfassung der Begleitumstände können sich die entscheidenden Hinweise auf die Ursache der Dyspnoe bereits bei Erstkontakt ergeben. Nach Überprüfung und ggf. notwendiger Sicherung der Vitalfunktionen kann eine differentialdiagnostische Einordnung nach kardialen, pulmonalen, vaskulären oder sonstigen Ursachen der Dyspnoe erfolgen. Dabei sollte bedacht werden, dass zugrundeliegende somatische Störungen durch die angstgetriggerte Hyperventilation überlagert sein können. Entsprechend der Häufigkeiten werden durch stufenweise Diagnostik kardiale, vaskuläre und pulmonale Störungen ausgeschlossen. Bei den apparativen Methoden sind das EKG, die Röntgenaufnahme des Thorax, die Echokardiographie und die Computertomographie des Thorax von grundlegender Bedeutung. Ihr Einsatz begründet sich in diagnostischen Wahrscheinlichkeiten, die wiederum auf Anamnese, den Umständen, dem klinischen Erscheinungsbild und rasch verfügbaren diagnostischen Tests basieren. In der Differenzierung der plötzlichen Dyspnoe können neben Blutdruck, EKG, Röntgenbild und Echokardiographie auch ein Thorax-CT wegweisend sein. Die einfache Peak-Flow-Messung und die Kapnometrie können ebenfalls hilfreich sein, wobei deren Anwendung in der Praxis noch selten erfolgt. Während für die Diagnostik und Therapie der akuten venösen Thromboembolie, des akuten Koronarsyndroms, akuter Herzrhythmusstörungen, des dissezierenden Aortenaneurysmas, des Status asthmaticus bzw. der COPD-Exazerbation etablierte Leitlinien existieren, sind solche für die breite Differenzialdiagnostik des häufigen Symptoms der plötzlichen Dyspnoe nicht vorhanden.

Abstract

Sudden dyspnea is a threatening symptom commonly associated with fear and panic. Questioning persons affected and surveying the attendant circumstances can give initial indications on the cause. After checking and if necessary securing vital signs a differential diagnostic classification into cardiac, pulmonary, vascular and other causes of dyspnea is recommended. It should be taken into consideration that somatic disturbances and anxiety-induced hyperventilation can interfere with each other. Due to the incidences, cardiac, pulmonary and vascular disturbances, in this order, should be excluded as possible causes for dyspnea. An electrocardiogram (ECG), X-ray of the chest, echocardiography and computed tomography (CT) can support the clinical examination. For differential diagnosis of sudden dyspnea, apart from blood pressure, ECG, X-ray and echocardiography, CT scans of the thorax can also be seminal. Peak-flow measurement and capnometry can be helpful in differentiating causes of sudden dyspnea but are rarely used in clinical practice. Whilst specific clinical guidelines exist for the diagnosis of vascular (pulmonary embolism) and cardiac (heart failure, heart attack) causes of sudden dyspnea, none are established for a general differential diagnosis of this common symptom.

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  1. Klinik und Poliklinik für Innere Medizin B, Ernst-Moritz-Arndt Universität Greifswald, Universitätsmedizin, Friedrich-Loeffler-Str. 23, 17489, Greifswald, Deutschland

    R. Ewert, S. Gläser, B. Koch & C. Schäper

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  1. R. Ewert
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  2. S. Gläser
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  3. B. Koch
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  4. C. Schäper
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Ewert, R., Gläser, S., Koch, B. et al. Plötzliche Dyspnoe. Pneumologe 9, 279–284 (2012). https://doi.org/10.1007/s10405-011-0569-4

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