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Chronic Dyspnea

History of present illness

Onset/duration/frequency/exacerbating factors Chest pain CPAP machine at night Cough Environmental/occupational exposure Home oxygenLower extremity swelling Melena Pleuritic pain PND/Orthopnea Previous chemotherapy Tobacco use Wheezing

Dyspnea (chronic)

Physical Exam

Pink/thin/tachypneic Cyanotic/plethoric/comfortable Vitals, O2 saturation JVD Cheyne-Stokes respiration Wheezing/rhonchi/air movement/breath sounds Fine inspiratory crackles S3,S4, Murmur Barrel shaped chest Abdominal distension/fluid wave Lower extremity edema Cyanosis/clubbing

Initial Labs/Radiology Follow-up

CBC Electrolytes CXR Arterial blood gas ECG Pulmonary function tests TSH/FT4 Alpha One antitrypsin Bronchoscopy Echocardiogram Right heart catheterization Exercise stress testing Open lung biopsy

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