What Causes Breathing Difficulty Despite A Normal Cardiac Test Report?

Brief Answer:
Clinical Examination with Symptomatic Approach

Detailed Answer:
Dear
Thanks for contacting with the health issue and following is my approach to a patient with sudden onset breathlessness:

1. first thing to differentiate is that is this breathing problem respiratory or cardiac in origin for which following questionnaire is asked from the patient:

i. do you get OR were there wheezing [whistling] sounds while breathing? [could be asthma,if absent could be else]
ii. Do you get such attacks on & off?
iii. Do you get breathless on walking?or do you get edema feet? [if yes, maybe its congestive cardiac failure [CCF]]
iv. do you have fever,cough, or expectoration? [ if yes, sign of infection,which may be the precipitating factor]
v. do you have chest pain/sweating? [whether yes or no,when a middle aged [50 years] or elderly man complains of sudden breathlessness,one must think of myocardial infarction (MI) with left ventricular failure (LVF)]

2. one must look for;
. cyanosis [bluish discolouration] in tongue/finger(s) and movements of accessory muscle of respiration [alae nasi and neck muscles] to know the severity of breathlessness.

3. General Examination to look for CCF:
. dilated neck veins,swelling of legs,and tender soft liver enlargement

4. Auscultation of the chest should be done for Air entry, i.e:
. If absent on one side: suggests sudden pneumothorax, or effusion
. presence of ronchii suggests bronchospasm [bronchial asthma or emphysema]
. rhonchii with poor air entry: emphysema
. fine crepts in the lung bases [acute LVF/MI]

5. If all the heart related test are normal and there are no signs at all in the chest except breathlessness, consult a Medicine or Chest Specialist to exclude metabolic causes like diabetic Ketoacidosis,Renal failure,dilated Cardiomyopathy if alcoholic] or Anxiety/Hysteria,Neuromuscular or Cardiac [restrictive/valvular]

6. Ask for: X-ray Chest,ECG and if Normal then Blood sugar and Serum Electrolytes,CT chest,Pulmonary Function Test [PFT],D-dimer test,right heart cewtheterization or bronchoscopy [may be needed].


Dr. Munish Sood
Consultant Physician
Naimittika

direct online link: bit.ly/drmunishsood

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