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November 7, 1977

Separating Cardiac From Pulmonary Dyspnea

JAMA. 1977;238(19):2066-2067. doi:10.1001/jama.1977.03280200078032

DYSPNEA is an uncomfortable awareness of the act of breathing, leading to a sensation most conveniently described as breathlessness. It may arise as a result of numerous mechanisms.1,2 However, in both cardiac and pulmonary disease, the most common cause is disordered lung mechanics.

The two major forms of disordered lung mechanics that result in pulmonary dyspnea are obstructive lung diseases, causing increased airway resistance, and restrictive lung diseases, causing increased lung stiffness. In patients with cardiac dyspnea, the major cause of dyspnea also is increased lung stiffness, leading to a type of restrictive lung disease.

As a result, patients with dyspnea purely related to obstructive lung disease seldom pose a problem in the separation of cardiac and pulmonary dyspnea. Hyperinflated lungs, prolonged expiration, a small heart, and the bedside and laboratory evidence of airways obstruction are easily documented.

The situation with respect to the restrictive lung diseases is more