A Logic and Critical Analysis of Problems in The Scenario According to References (Evidence

Based Learning)

Patients present with complaints of shortness of breath so that from these problems many
different diagnoses arise. Identified one by one organ which can cause shortness of breath,
namely abnormalities in the lungs, heart, musculoskeletal, and brain and can arise from
metabolic abnormalities or neurological disorders.

To make a diagnosis of a case anamnesis is needed so that we can get valid information and be
supported by a physical examination.

Shortness of breath due to lung abnormalities can arise due to pulmonary edema, bronchitis,
bronchiectasis, asthma, copd, pleural effusion, emphysema, pulmonary fibrosis, pneumothorax,
and pulmonary embolism. But from the history and physical examination it was found that the
patient did not experience coughing so that congestion due to lung abnormalities can be excluded
because most abnormalities in the lung and respiratory tract had cough symptoms.

Shortness of breath due to heart abnormalities can arise due to right heart failure, left heart
failure, valve abnormalities, birth defects, acute myocard infarction, and angina pectoris. From
the results of the history and physical examination it was found that the patient had no birth
abnormalities, no edema and no right heart widening which meant no abnormalities of right heart
failure, there was widening of the left heart border and pulmonary congestion which could be
caused by left heart failure. there is no gallop and murmur which means there is no valve
abnormality or stenosis, there is old myocard infarction anterior to ecg examination which means
that the diagnosis of acute myocardial infarction can be excluded, and there is no chest pain
which means the patient does not experience angina pectoris. So from a different diagnosis of the
heart one diagnosis is obtained, namely left heart failure.

The patient is not agitated, the damage hypothesis in the brain, especially in the brain stem part
can be excluded because the respiratory center is in the brain stem.

From the musculoskeletal system there is no fracture or trauma in the patient so the hypothesis of
shortness of breath due to musculoskeletal abnormalities can be excluded.
The patient's urine is normal which means there is no metabolic abnormality or respiratory
acidosis as the cause of the patient's shortness of breath.

The patient also did not experience muscle weakness so the diagnosis of tightness due to
myasthenia gravis and Guillain Barre Syndrome can be excluded.

From the analysis above, one diagnosis is obtained, namely that the patient experiences shortness
of breath due to left heart failure.