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What Causes Breathing Difficulty Despite A Normal Cardiac Test Report?
Question: My brother in law[approx.50yrs] had sudden breathing problem at 2:00am today in night as he was unable to breath and was admitted in hospital where all heart related tests were done and nothing serious was found but was given oxygen thru mask to him and hospital adviced to take him to ENT specialist to rule out any issues. Now he is in home and no oxygen is giving to him and sleping. Could you please suggest the reason along with tests/correct line of treatment urgently.
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
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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Above answer was peer-reviewed by :
Dr. Nagamani Ng
Answered by
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