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Yale University
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Joe Sims: Interview

Dr. Grey: Joe, it's good to see you. How's the music business?

Joe: Not so good. That's why I'm here. I'm having a lot of trouble with my breathing, especially when I blow my horn.

Dr. Grey: Go on.

Joe: It has me worried. I had to cancel out on a road tour last week because I couldn't play the charts in rehearsal. I could barely get through the head, and I wasn't able to play solos. I had to make up an excuse that I had a cold and leave the studio early.

Dr. Grey: Any other times that you feel short of breath?

Joe: Pretty much whenever I do something, especially walking and climbing the subway stairs in New York City.

Dr. Grey: Anything make it better?

Joe: Yeah. If I stop what I'm doing and cool it for about a minute, my breathing quiets down.

Dr. Grey: Does it wake you up from your sleep?

Joe: No.

Dr. Grey: When did it begin?

Joe: Thinking back on it, I would say it's been coming on for about a year, real slow at first.

Dr. Grey: Have you noticed any swelling in your feet?

Joe: Nope.

Dr. Grey: Any pain in your chest?

Joe: I would have been in to see you if I had.

Dr. Grey: Have you ever been told of high blood pressure?

Joe: I visited a clinic in San Francisco about a year ago when I sprained my ankle. The nurse said my blood pressure was “perfect.”

Dr. Grey: Have you had a cough or wheeze, or asthma?

Joe: No.

Dr. Grey: Any fever or chills?

Joe: Maybe when I had the flu two years ago, but not since.

Dr. Grey: Are you taking any medications?

Joe: Just an occasional aspirin for a headache.

Dr. Grey: Do you mind if I ask a few questions about your habits?

Joe: Fire away.

Dr. Grey: Do you smoke tobacco or marijuana?

Joe: Never.

Dr. Grey: How about recreational drugs? Do you ever use them?

Joe: No way. Couldn't play my horn if I did.

Dr. Grey: Alcohol?

Joe: Gave it up 10 years ago. It used to put me to sleep, especially on club dates. I'll take a selzer on the rocks with a twist of lime, if you've got it.

Dr. Grey: Coming right up! But first, let's step into the exam room so I can examine you and try to figure out what's going on.

Joe: You saved my life once, Dr. Grey. I'm depending on you for a repeat performance.

Self-assessment question:

Which of the following is least likely to be the cause of Joe Sim's shortness of breath?

a. Hematologic disorder

b. Psychiatric disorder

c. Pulmonary disorder

d. Neuromuscular disorder

e. Cardiac disorder

The correct answer is b., psychiatric disorder. The differential diagnosis of dyspnea is broad and includes multiple organ systemns. Dyspnea secondary to a psychiatric disorder such as panic attack or chronic anxiety more often occurs at rest and in the context of other psychiatric symptoms. What are some examples of disorders effecting the organ systems mentioned in the question, that might cause dyspnea?

Next: Physical examination