Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 26 , ISSUE 1 ( January, 2022 ) > List of Articles

Original Article

Differentiating Cardiac and Pulmonary Causes of Dyspnea Using Ultrasonography and Dyspnea Discrimination Index

Gina M Chandy, Sowmya Sathyendra, Darpanarayan Hazra, Kundavaram PP Abhilash

Keywords : Cardiac dyspnea, Dyspnea, Dyspnea Discrimination Index, Pulmonary dyspnea, Ultrasonography

Citation Information : Chandy GM, Sathyendra S, Hazra D, Abhilash KP. Differentiating Cardiac and Pulmonary Causes of Dyspnea Using Ultrasonography and Dyspnea Discrimination Index. Indian J Crit Care Med 2022; 26 (1):33-38.

DOI: 10.5005/jp-journals-10071-24089

License: CC BY-NC 4.0

Published Online: 17-01-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

Background: One of the most common reasons for emergency room (ER) visits is acute dyspnea. The challenge is in differentiating a cardiac and pulmonary cause of acute breathlessness. Hence, we have studied the effectiveness of the dyspnea discrimination index (DDI) used in conjunction with ultrasonography (USG) in distinguishing between cardiac and pulmonary causes of dyspnea. Methods: This was a prospective study conducted in the ER and general medicine wards to evaluate the efficacy of the DDI and USG in dyspneic patients. Data were entered in a standard data sheet and analysis was done using SPSS software. Results: The majority of the patients were between the ages of 45 and 60, with a male predominance. Risk factors like smoking were more common in the pulmonary group (36%). Pulmonary cause of breathlessness was seen in 62% of patients and cardiac pathology was noted in 28%. The mean (SD) DDI value and DDI% are as follows: pulmonary group (DDI)—5.47 (SD: 2.82); cardiac group (DDI)—8.34 (SD: 3.75); pulmonary group (DDI%)—1.31 (SD: 0.68); cardiac group (DDI%)—2.34 (SD: 1.14). There was a significant difference in DDI% between the pulmonary and cardiac groups (p = 0.001). DDI was found to have a sensitivity and specificity of 77.3% and 70%, respectively. While for DDI%, sensitivity and specificity were 72.7% and 72%, respectively. Lung USG had 98% sensitivity and 95.5% specificity, with a narrow confidence interval. The positive likelihood ratio was noted to be 21.6, indicating a very high post-test probability. Conclusion: The DDI and USG in conjunction had good discriminative power, when it came to distinguishing between cardiac and pulmonary causes of dyspnea. USG had a high specificity and sensitivity, making it suitable for identifying the cause of dyspnea in a tertiary care ER setting.


HTML PDF Share
  1. Woollard M, Greaves I. 4 Shortness of breath. Emerg Med J 2004;21(3):341–350. DOI: 10.1136/emj.2004.014878.
  2. Ray P, Birolleau S, Lefort Y, Becquemin M-H, Beigelman C, Isnard R, et al. Acute respiratory failure in the elderly: etiology, emergency diagnosis and prognosis. Crit Care 2006;10(3):R82. DOI: 10.1186/cc4926.
  3. Dyspnea. Am J Respir Crit Care Med 1999;159(1):321–340. DOI: 10.1164/ajrccm.159.1.ats898.
  4. McNamara RM, Cionni DJ. Utility of the peak expiratory flow rate in the differentiation of acute dyspnea. cardiac vs pulmonary origin. Chest 1992;101(1):129–132. DOI: 10.1378/chest.101.1.129.
  5. Malas O, Cağlayan B, Fidan A, Ocal Z, Ozdoğan S, Torun E. Cardiac or pulmonary dyspnea in patients admitted to the emergency department. Respir Med 2003;97(12):1277–1281. DOI: 10.1016/j.rmed.2003.07.002.
  6. Ailani RK, Ravakhah K, DiGiovine B, Jacobsen G, Tun T, Epstein D, et al. Dyspnea differentiation index: a new method for the rapid separation of cardiac vs pulmonary dyspnea. Chest 1999;116(4):1100–1104. DOI: 10.1378/chest.116.4.1100.
  7. Seif D, Perera P, Mailhot T, Riley D, Mandavia D. Bedside ultrasound in resuscitation and the rapid ultrasound in shock protocol. Crit Care Res Pract 2012;2012:503254. DOI: 10.1155/2012/503254.
  8. Pearson SB, Pearson EM, Mitchell JR. The diagnosis and management of patients admitted to hospital with acute breathlessness. Postgrad Med J 1981;57(669):419–424. DOI: 10.1136/pgmj.57.669.419.
  9. Berliner D, Schneider N, Welte T, Bauersachs J. The differential diagnosis of dyspnea. Dtsch Arztebl Int 2016;113(49):834–845. DOI: 10.3238/arztebl.2016.0834.
  10. Raffin TA, Theodore J. Separating cardiac from pulmonary dyspnea. JAMA 1977;238(19):2066–2067. PMID: 578913.
  11. Kajimoto K, Madeen K, Nakayama T, Tsudo H, Kuroda T, Abe T. Rapid evaluation by lung-cardiac-inferior vena cava (LCI) integrated ultrasound for differentiating heart failure from pulmonary disease as the cause of acute dyspnea in the emergency setting. Cardiovasc Ultrasound 2012;10(1):49. DOI: 10.1186/1476-7120-10-49.
  12. Manson W, Hafez NM. The rapid assessment of dyspnea with ultrasound: RADiUS. Ultrasound Clin 2011;6(2):261–276. DOI: 10.1016/j.cult.2011.03.010.
  13. Goffi A, Pivetta E, Lupia E, Porrino G, Civita M, Laurita E, et al. Has lung ultrasound an impact on the management of patients with acute dyspnea in the emergency department? Crit Care 2013;17(4):R180. DOI: 10.1186/cc12863.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.