The patient with dyspnea. Rational diagnostic evaluation

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.