Breathlessness is a very common feature of the early stages of myocardial infarction and may be the only clinical complaint. Sudden onset of breathlessness, particularly in the elderly, should always trigger suspicion of acute myocardial infarction. The reason for this is the increase in myocardial stiffness (diastolic dysfunction) which rapidly (within a few minutes) follows myocardial ischemia and equally rapidly resolves upon relief of ischemia. The left atrial and pulmonary artery wedge pressures rise rapidly, and so the lungs stiffen and may develop frank edema. The symptom has to be distinguished from other causes of sudden dyspnea: late-onset asthma, pneumothorax, pneumonia, or pulmonary embolism.
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