Patient with orthopnea

Perform detailed history and physical examination

Conduct tests needed to confirm diagnosis: Complete blood count, metabolic profile, chest radiograph, electrocardiogram, spirometry, pulse oximetry

Is the diagnosis evident?

Yes No

Possible diagnoses: Conduct tests needed to confirm diagnosis: Echocardiogram, brain natriuretic peptide, pulmonary function testing, arterial blood
Asthma gas, high-resolution computed tomography, Holter monitor, radionuclide study, ventilation-perfusion (V/Q) scan
Chronic obstructive pulmonary disease
Congestive heart failure
Anemia
Is the diagnosis evident?
Kyphoscoliosis

Yes No

Possible diagnoses: Conduct tests needed to confirm diagnosis (specialty consultation for these tests): Cardiac
Pericardial disease catheterization, cardiopulmonary exercise testing, bronchioscopy, esophageal pH, lung biopsy
Congestive heart failure
Valvular heart disease
Coronary artery disease Is the diagnosis evident?
Cardiac arrhythmia
Restrictive lung disease
Interstitial lung disease
Chronic pulmonary embolism Yes No

Possible diagnoses: Consider:

Gastroesophageal reflux disease Psychogenic dyspnea
Coronary artery disease Specialty consultation
Deconditioning
Primary pulmonary hypertension