Differentiating Cardiac and Pulmonary Causes of Dyspnea

Dyspnea is a common presenting symptom in emergency departments and may signal life-threatening cardiac or pulmonary pathology. Differentiating these causes can be challenging because of overlapping clinical manifestations, particularly among older adults with multiple comorbidities. This case series highlights the importance of systematic clinical assessment and targeted investigations in distinguishing cardiac from pulmonary causes of acute dyspnea. We conducted a retrospective case series at Hospital Sultanah Nur Zahirah, Kuala Terengganu, involving two patients who presented with acute shortness of breath. We reviewed patients’ medical records for clinical histories, physical examination findings, laboratory results, imaging studies, treatment interventions, and clinical outcomes. The first case involved a 71-year-old man with hypertension, diabetes mellitus, ischemic heart disease, and atrial fibrillation who presented with severe dyspnea, marked hypertension, hypoxemia, bilateral basal crackles, peripheral edema, and radiographic pulmonary congestion. He was diagnosed with acute decompensated biventricular heart failure precipitated by severe hypertension, complicated by respiratory failure, and improved after noninvasive ventilation, intravenous glyceryl trinitrate, and diuretic therapy. The second case involved a 73-year-old man with post-tuberculosis bronchiectasis and diabetes mellitus who presented with acute dyspnea, productive cough, tachypnea, bilateral coarse crepitations, rhonchi, and right-sided pulmonary consolidation. He was diagnosed with an infective exacerbation of bronchiectasis associated with pneumonia and respiratory failure, requiring respiratory support and antimicrobial therapy. These contrasting cases underscore the importance of integrating clinical history, physical examination, physiological measurements, and imaging to determine the predominant cause of dyspnea. A structured diagnostic approach, supported by repeated clinical reassessment, facilitates timely recognition and etiology-directed management, potentially reducing complications associated with delayed or inappropriate treatment. Keywords Dyspnea; heart failure; bronchiectasis; respiratory failure; differential diagnosis; emergency medicine.