[Dyspnea upon exertion in systemic scleroderma: from symptom to etiological diagnosis].
Pulmonary hypertension and interstitial lung disease are the two main causes of death in systemic sclerosis. The hallmark of these complications is dyspnea on exertion. Assessment of dyspnea in systemic sclerosis is based on a questionnaire; 6-minute walk test and Borg index. After excluding anemia, a deceptive cause mainly due to digestive haemorrhage, echocardiography, pulmonary function tests and high resolution computed tomography of the chest are the first step to diagnosis. Peak velocity of tricuspid regurgitation as measured by echocardiography is the main parameter to evaluate the risk of pulmonary hypertension before performing a right heart catheterization. Diastolic left ventricle dysfunction is another frequently encountered cause of dyspnea in systemic sclerosis. Other less common causes are pericarditis, respiratory muscle involvement, lung cancer, pulmonary embolism.
Hachulla
Eric
E
Centre de référence des maladies auto-immunes et des maladies systémique rares sclérodermie systémique, Service de Médecine interne, Hôpital Claude Huriez, CHRU, F-59037 Lille Cedex, France. ehachulla@chru-lille.fr
Bervar
Jean François
JF
Launay
David
D
Lamblin
Nicolas
N
Perez
Thierry
T
Mouthon
Luc
L
De Groote
Pascal
P
Tillie-Leblond
Isabelle
I
Humbert
Marc
M
D000203:Activities of Daily Living; D000465:Algorithms; D000740:Anemia / Q000209:etiology; D006328:Cardiac Catheterization; D002423:Cause of Death; D003663:Decision Trees; D003937:Diagnosis, Differential; D004417:Dyspnea / Q000175:diagnosis / Q000209:etiology; D004452:Echocardiography; D005080:Exercise Test; D017079:Exercise Tolerance; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology; D017563:Lung Diseases, Interstitial / Q000209:etiology; D008487:Medical History Taking; D012129:Respiratory Function Tests; D012595:Scleroderma, Systemic / Q000150:complications* / Q000175:diagnosis* / Q000401:mortality; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014057:Tomography, X-Ray Computed; D014262:Tricuspid Valve Insufficiency / Q000209:etiology; D018487:Ventricular Dysfunction, Left / Q000209:etiology