Optional medical device diagnostics – depending on the results of the history, physical examination, laboratory diagnostics, and obligatory medical device diagnostics – for differential diagnostic clarification.
- Blood pressure measurement [< 90 mmHg → shock]
- Pulse oximetry* (method for non-invasive determination of arterial oxygen saturation via measurement of light absorption) [severity of hypoxia/oxygen deficiency].
- Electrocardiogram (ECG; recording of the electrical activity of the heart muscle)* – if cardiac arrhythmias, myocardial infarction (heart attack), etc. are suspected. [Note: In approximately 20% of patients with myocardial infarction, the initial ECG is unremarkable].
- Echocardiography (echo; cardiac ultrasound).
- Detection of regional wall motion abnormalities (WBS), valvular and septal vitiation (defects of the heart valves or heart wall), or diastolic dysfunction/heart failure.
- Exclusion of pericardial effusion (fluid accumulation in the pericardium) or its quantification.
- Exclusion of left or right ventricular dilatation (ventricular expansion of the left or right ventricle, respectively) or evidence of normal left and right ventricular function
- Exclusion of a congested vena cava (vena cava).
- Lung sonography (lung ultrasonography, LUS); part of the thoracic sonography; is performed as a “point-of-care ultrasound procedure” for the leading symptom “acute respiratory distress” for differential diagnosis by the emergency and acute care physician independently:
- Heart failure (cardiac insufficiency).
- Pulmonary artery embolism (LAE)
- Pleural effusion – pathologic (abnormal) increase in fluid content between the pleura parietalis (pleura) and pleura visceralis (pleura).
- Pneumothorax – collapse of the lung caused by an accumulation of air between the visceral pleura (lung pleura) and the parietal pleura (chest pleura).
- Pneumonia (pneumonia)
- X-ray of the thorax (X-ray thorax/chest), in two planes – as a basic diagnostic for suspected changes in the area of the lungs.
- [Pulmonary infiltrate in pneumonia/pneumonia.
- Prominent blood vessels, vascular congestion, and interstitial edema (e.g., so-called Kerley B-lines, peribronchial cuffing). Pleural effusions, cardiomegaly (cardiac enlargement) in heart failure/heart failure.
- Unilateral “air trapping” for foreign body aspiration]
- Pulmonary function examination [normal ventilation, obstruction, restriction?]
- Note: In elderly patients with dyspnea and without chronic obstructive pulmonary disease (COPD), a reduced MEF50 (mean airflow rate when 50% of forced vital capacitynoch is exhaled) may indicate occult heart failure.
- Peak flow measurement (measurement of expiratory volume).
- Exercise testing (6-minute walk test, spiroergometry, etc.) Spiroergometry is suitable for differentiating between cardiac and pulmonary dyspnea.
- Computed tomography of the thorax/chest (thoracic CT) – for suspected lung tumors, pneumothorax (accumulation of air in the pleural space, i.e. the space between the lungs and the chest wall), etc.
- Cardio-computed tomography (cardiac computed tomography, short cardio-CT) – CHD diagnostics (diagnostics due tocoronary artery disease) in dyspnea without angina pectoris (“chest tightness”; sudden pain in the heart area).
- Pleurasonography (ultrasound examination of the pleura (pleura) and pleural space) – if pleural effusion is suspected.
- Bronchoscopy (pulmonary endoscopy) – if foreign bodies, tumors, etc. are suspected.
- X-rays of the ribs/spine – if bony cause of dyspnea is suspected.
- Cardio-magnetic resonance imaging (cardio-MRI) – if cardiac abnormalities and inflammatory heart disease are suspected.
* Component of emergency management.
