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Clinical presentations—approaches to problems 

Clinical presentations—approaches to problems
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date: 21 November 2018

This chapter covers the broad topic of the symptom of breathlessness and the multiplicity of causes for this. A description of the physiological mechanisms causing the sensation of dyspnoea is given. There is a discussion of factors to consider in the clinical assessment of someone with breathlessness such as exacerbating factors, associated symptoms, family history. Particular reference to presenting features of bilateral diaphragmatic weakness, laryngeal stridor, and Cheyne-Stokes respiration is made, along with symptoms of orthopnoea and trepopnoea. Appropriate investigations are described, which clearly cover a broad range of possible differential diagnoses. A table of possible causes of breathlessness divides them by speed of onset: from instantaneous to acute, subacute, and chronic. Breathlessness with a normal chest radiograph is highlighted, along with episodic breathlessness. The often difficult clinical area of distinguishing between respiratory and cardiac causes of breathlessness is discussed, with appropriate investigations and how the results may help discriminate between the two.

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