Pocket Medicine

PULMONARYQ

DYSPNEA

Evaluation

•  History: quality of sensation, tempo, positional dependence, exac./allev. factors, exertion

•  Cardiopulmonary exam, SaO2, CXR (see Appendix & Radiology inserts), ECG predictors of CHF: h/o CHF, PND, S3, CXR w/ venous congestion, AF (  JAMA 2005;294:1944) dyspnea w/ nl CXR → CAD, asthma, PE, PHT, early ILD, anemia, acidosis, NM disease

•  Based on results of initial evaluation: PFT, chest CT, TTE, cardiopulmonary testing

•  BNP & NT-proBNP ↑ in CHF (also ↑ in AF, RV strain from PE, COPD flare, PHT, ARDS) BNP <100 pg/mL to r/o CHF (90% Se), >400 to r/i (NEJM 2002;347:161)

NT-proBNP <300 pg/mL to r/o CHF (99% Se); age-related cut points to r/i: >450 pg/mL (<50 y), >900 (50–75 y), >1800 (>75 y) (EHJ 2006;27:330)

↑ in chronic heart failure, ∴ need to compare to known “dry BNP”