Some differences between dyspnea of cardiac origin and dyspnea of pulmonary origin in the elderly

ABSTRACT

Acute dyspnea is a common problem among elderly patients. Few studies have examined acute dyspnea in the elderly. The most common causes of dyspnea in the elderly are either of cardiac origin include heart failure, or of pulmonary origin as chronic obstructive pulmonary disease and asthma. Other causes include parenchymal lung disease, pulmonary vascular diseases, upper airway obstruction and pneumonia. In clinical practice, it is often difficult to distinguish between cardiac and pulmonary causes of dyspnea. To detect some differences between cases of cardiac dyspnea and those suffering from pulmonary dyspnea in elderly patients admitted to the departement of Geriatrics in Ain Shams University hospital. All patients admitted to the department of Geriatrics in Ain Shams University hospital with acute dyspnea as a main complaint for a period of 6 months [56 patients] were evaluated by both clinical assessment and some investigations as arterial blood gases, chest X ray, ECG, echocardiography. Accordingly determination of the cause of dyspnea was made. Comparison between the three groups i.e. cardiac, pulmonary and mixed were made regarding number, mean age, mean PO2, delirium and ICU admission. The total number of patients presented to the geriatric department during the period of the study were 361 patients, so those 56 patients represented 15% from the total admission. 37.5% of cases were suffering from dyspnea of pulmonary origin. The rest were suffering from cardiac dyspnea [26.8%], mixed type [26.8%] and [8.9%] only were suffering from dyspnea due to other causes. The highest mean age was among the mixed group. There was no statistically significant difference between the three groups regarding sex, delirium and ICU admission. The lowest mean PaO[2] was among those with mixed cardiac and pulmonary dyspnea and the highest was among the cardiac group. In the elderly it is difficult to set out points of differentiation between dyspnea of cardiac origin and that of pulmonary origin. The number of mixed cases is relatively high. It was found also that there are other confounding factors which are important in predicting mortality and morbidity should be considered when we are assessing cases of acute dyspnea in the elderly