Abstract
Dyspnea is the uncomfortable awareness of difficult breathing. It is a common symptom in primary and nonprimary care settings. Although multiple disorders and diseases may cause breathlessness, the majority of the conditions are of cardiac or pulmonary origin. The challenge is to establish the diagnosis timely and with minimized investigations. Frequently, information about onset, progression, and circumstances of occurrence considerably narrow the underlying etiology. In most cases, a carefully taken history and a comprehensive physical examination lead to the correct diagnosis. Nevertheless, one should be aware of concomitant conditions and not be satisfied with a diagnosis if comorbidity may still be a candidate in causing dyspnea. Otherwise, it has been observed that chronic obstructive pulmonary disease was over-diagnosed in patients with systolic heart failure and dyspnea. A prudential use of investigating modalities for confirmation and exclusion of a questionable diagnosis is the key for allocating the correct therapy and achieving fast symptom relief in patients with dyspnea.
Zusammenfassung
Dyspnoe ist die Wahrnehmung der erschwerten Atmung. Atemnot ist ein weit verbreitetes Symptom sowohl in der Erstversorgung von Akutpatienten als auch in der Routinebetreuung. Obwohl unterschiedlichste Erkrankungen zu Dyspnoe führen können, sind oft das Herz-Kreislauf-System und die Atmungsorgane betroffen, wobei das kardiogene Lungenödem die häufigste Ursache darstellt. Die Herausforderung besteht darin, rechtzeitig und ohne unnötig aufwendige Untersuchungen den Grund für eine Atemnot zu identifizieren. Oft lassen sich bereits anhand von Beginn, Verlauf und Begleitumständen der Dyspnoe die möglichen Diagnosen stark einschränken. In den meisten Fällen verweisen eine genaue Anamnese und eine sorgfältige körperliche Untersuchung bereits auf die korrekte Diagnose. Nichtsdestotrotz sollten plausible Komorbiditäten als Ursache für eine Dyspnoe ebenso in Betracht gezogen werden. Andererseits wurde bereits gezeigt, dass eine chronisch obstruktive Lungenerkrankung bei Patienten mit systolischer Herzinsuffizienz und Dyspnoe häufig überdiagnostiziert wird. Das heißt, ein besonnener Einsatz der diagnostischen Modalitäten zum Nachweis oder Ausschluss fragwürdiger Ursachen ist von Nöten, um die korrekte Therapie einzuleiten und eine schnelle Symptombesserung für den Patienten mit Atemnot zu erzielen.
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Conflict of interest. S. Brenner and G. Güder state that are no conflicts of interest. The accompanying manuscript does not include studies on humans or animals.
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Brenner, S., Güder, G. The patient with dyspnea. Herz 39, 8–14 (2014). https://doi.org/10.1007/s00059-014-4057-6
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DOI: https://doi.org/10.1007/s00059-014-4057-6