Evaluation of the acutely dyspneic elderly patient.

Dyspnea is among the most frequent complaints in the elderly. The prevalence of comorbid medical conditions and the physiologic changes of aging present significant challenges in determining the cause. The initial approach to the elderly dyspneic patient mandates consideration of a broad range of diagnoses. Failure to diagnose life-threatening medical conditions presenting with dyspnea such as pulmonary embolus, acute coronary syndromes, congestive heart failure, asthma, obstructive pulmonary disease, pneumothorax, and pneumonia can lead significant morbidity and mortality. This article focuses on the rapid assessment and approach to the acutely dyspneic elderly patient.

[1]  C. Beigelman,et al.  Acute respiratory failure in the elderly: etiology, emergency diagnosis and prognosis , 2006, Critical care.

[2]  C. Camargo,et al.  The N-terminal Pro-BNP investigation of dyspnea in the emergency department (PRIDE) study. , 2005, The American journal of cardiology.

[3]  H. L. Hodge,et al.  Diagnostic evaluation of dyspnea. , 1998, American family physician.

[4]  N. Ayas,et al.  Does this dyspneic patient in the emergency department have congestive heart failure? , 2005, JAMA.

[5]  C. Camargo,et al.  Amino-terminal pro-brain natriuretic peptide for the diagnosis of acute heart failure in patients with previous obstructive airway disease. , 2006, Annals of emergency medicine.

[6]  R. Jayadevappa,et al.  Nonspecific Presentation of Pneumonia in Hospitalized Older People: Age Effect or Dementia? , 2000, Journal of the American Geriatrics Society.

[7]  R. Cody,et al.  Age-related differences in diagnoses within the elderly population. , 1998, The American journal of emergency medicine.

[8]  S. Gottlieb,et al.  Acute congestive heart failure in the emergency department. , 2006, Cardiology clinics.

[9]  P. Thomas.  "I can't breathe"--assessment and emergency management of acute dyspnoea. , 2005, Australian family physician.

[10]  T. Marrie.  Community-acquired pneumonia in the elderly. , 2000, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[11]  T. D. Robinson,et al.  The role of hypoventilation and ventilation-perfusion redistribution in oxygen-induced hypercapnia during acute exacerbations of chronic obstructive pulmonary disease. , 2000, American journal of respiratory and critical care medicine.

[12]  C. Hanson,et al.  Causes of hypercarbia with oxygen therapy in patients with chronic obstructive pulmonary disease. , 1996, Critical care medicine.

[13]  Mel Herbert,et al.  The mortality of untreated pulmonary embolism in emergency department patients. , 2005, Annals of emergency medicine.

[14]  W. Aronow.  Silent MI. Prevalence and prognosis in older patients diagnosed by routine electrocardiograms. , 2003, Geriatrics.

[15]  M. Fine,et al.  Guidelines for the management of adults with community-acquired pneumonia. Diagnosis, assessment of severity, antimicrobial therapy, and prevention. , 2001, American journal of respiratory and critical care medicine.

[16]  C. Vergnes,et al.  Use of N-terminal prohormone brain natriuretic peptide assay for etiologic diagnosis of acute dyspnea in elderly patients. , 2006, American heart journal.

[17]  David Brieger,et al.  Acute coronary syndromes without chest pain, an underdiagnosed and undertreated high-risk group: insights from the Global Registry of Acute Coronary Events. , 2004, Chest.

[18]  Rohit Gupta,et al.  Cardiovascular emergencies in the elderly. , 2006, Emergency medicine clinics of North America.

[19]  Sadi Kaya,et al.  A comprehensive analysis of traumatic rib fractures: morbidity, mortality and management. , 2003, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[20]  K. Eagle,et al.  Baseline characteristics, management practices, and in-hospital outcomes of patients hospitalized with acute coronary syndromes in the Global Registry of Acute Coronary Events (GRACE). , 2002 .

[21]  Jerome D. Cohen,et al.  Troponin I in patients without chest pain. , 2004, Clinical chemistry.

[22]  J. Luketich,et al.  Management of spontaneous pneumothorax: an American College of Chest Physicians Delphi consensus statement. , 2001, Chest.

[23]  R. Rodríguez-Roisín,et al.  Community-acquired pneumonia in the elderly: A multivariate analysis of risk and prognostic factors. , 1996, American journal of respiratory and critical care medicine.

[24]  J. Collins,et al.  Assessment and management of acute asthma in the elderly: a comparison with younger asthmatics , 1982, Postgraduate medical journal.

[25]  Y. Dohi,et al.  Circulating concentrations of cardiac proteins indicate the severity of congestive heart failure , 2003, Heart.

[26]  P. Barnes,et al.  Chronic obstructive pulmonary disease. , 2000, The New England journal of medicine.

[27]  Jon G Ayres,et al.  Epidemiology of pneumothorax in England , 2000, Thorax.

[28]  L. Jacobs.  Managing respiratory symptoms at the end of life. , 2003, Clinics in geriatric medicine.

[29]  M. Niederman,et al.  Community-acquired pneumonia in elderly patients. , 2003, Clinics in geriatric medicine.

[30]  E. Haponik,et al.  Respiratory failure in elderly patients. , 2003, Clinics in geriatric medicine.

[31]  A. Panju,et al.  Does this patient have pulmonary embolism? , 2003, JAMA.

[32]  S. Braman.  Asthma in the elderly. , 2003, Experimental lung research.

[33]  M. Pfisterer,et al.  Use of B-type natriuretic peptide in the evaluation and management of acute dyspnea. , 2004, The New England journal of medicine.

[34]  Douglas W Mahoney,et al.  Burden of systolic and diastolic ventricular dysfunction in the community: appreciating the scope of the heart failure epidemic. , 2003, JAMA.

[35]  J. Ting.  Hypercapnia and oxygen therapy in older asthmatic patients , 2004, European journal of emergency medicine : official journal of the European Society for Emergency Medicine.

[36]  J. Yernault.  Dyspnoea in the Elderly , 2001, Drugs & aging.

[37]  L. Sanchez,et al.  Pulmonary emergencies in the elderly. , 2006, Emergency medicine clinics of North America.

[38]  J. Arnsten,et al.  Diagnosis and treatment of pulmonary embolism in the elderly. , 2003, Clinics in geriatric medicine.