Difficulty in the differential diagnosis of chronic dyspnea in the elderly

Dyspnea is a painful sensation of lack of air. It has both subjective and objective manifestations and is well-known in the clinical practices of doctors of many specialties. The most common causes of shortness of breath are respiratory and cardiovascular diseases, neuromuscular disorders, psychosomatic conditions, and metabolic disorders. Acute dyspnea, which lasts up to one month, and chronic shortness of breath, which lasts more than one month, are both characterized by a spectrum of pathological conditions. Chronic dyspnea in older people can be a challenge to diagnose because of age-related changes, the atypical course of diseases, comorbidity, and possible polypharmacy. The presented clinical case describes the experience of treating an elderly patient with a chronic dyspnea that had a complex genesis. During the follow-up the patient gradually developed diseases, each of which manifested as shortness of breath: atrial fibrillation, which subsequently led to chronic heart failure; mixed anemia due to iron, folate, and B12 deficiency; and finally, systemic sclerosis-associated pulmonary hypertension. The search for new reasons of dyspnea has become possible due to a dynamic reassessment of the patient’s condition, which involves analyzing changes in the clinical findings, expanding the range of laboratory and instrumental examinations and involving specialists from diverse disciplines. Modern diagnostic algorithms and a multidisciplinary approach are important tools for managing patients with chronic dyspnea.

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