[Acute dyspnoea in elderly patients]

There is a natural physiological decline in pulmonary function and the cardiovascular system with age. In emergency medicine, acute dyspnoea is a common problem among elderly patients. Some causes, such as pulmonary embolism and diastolic heart failure, are probably under-diagnosed. A good clinical history and examination are as important as arterial blood gas analysis, chest radiography and electrocardiography. Few studies have examined acute dyspnoea in elderly patients, except in the setting of pneumonia. Establishing the underlying diagnosis is often difficult because of atypical presentation and the interaction between cardiac and pulmonary underlying functions. This topic describes several respiratory and cardiac diseases presenting as acute dyspnoea, especially "cardiac asthma" and pulmonary embolism. The clinical usefulness of new investigations such as cardiac and lung echography, pulmonary function tests, serum Brain Natriuretic Peptide and thoracic CT scan are discussed. Further studies looking at acute dyspnoea in elderly patients are needed.