Upper airway obstruction Pulmonary disorders Obstructive lung disease Airway mass Asthma Bronchitis Emphysema Pleural effusion Pneumonia Pneumothorax Pulmonary embolism Pulmonary hypertension Restrictive lung disease Malignancy

222 Acute dyspnea may occur in the context of medical emergencies such as airway obstruction, pneumothorax, pulmonary embolism, and myocardial infarction. Chronic exertional dyspnea progressing to dyspnea at rest, as in this patient, suggests worsening pulmonary disease or heart failure. Orthopnea (dyspnea when supine) and trepopnea (dyspnea in the decubitus position) are suggestive of heart failure. Paroxysmal nocturnal dyspnea may occur in heart failure, bronchitis, or asthma.1 Productive cough suggests pulmonary disease. Chest pain may occur in both pulmonary and cardiac disorders; a proper pain history will provide clues as to the cause of pain, but it may be difficult to exclude myocardial ischemia on history and physical examination alone,2,3 particularly in women.