Diagnostic approach to acute severe dyspnea in low-middle-income countries

Acute severe dyspnoea is a critical medical emergency frequently encountered in low- and middle-income countries, where resource limitations significantly challenge timely diagnosis and management. Our institutional protocol (PGIMER, Chandigarh) offers a practical approach tailored to these constraints. It emphasises a structured clinical assessment and prioritises readily available basic investigations, including chest radiography, arterial blood gas analysis, and electrocardiogram, to differentiate common aetiologies such as pulmonary embolism, pneumonia, cardiac tamponade, and acute heart failure. The diagnostic approach is structured across seven clinical domains-<i>R</i>isk factors, <i>H</i>istory, <i>E</i>xamination findings, <i>L</i>aboratory results, <i>I</i>maging features, <i>T</i>reatment (empirical) response, and <i>A</i>lternate diagnosis exclusion (mnemonic <i>RHELITA</i>). A simplified diagnostic algorithm for pulmonary embolism is included to optimize use of advanced imaging.