The Clinical Problem Solvers Episode 439 – Spaced Learning Series – SOB
Jan 21, 2026
Dive into the fascinating case of a 73-year-old woman grappling with dyspnea, where hosts unravel the dyspnea pyramid and key triage questions. Explore intriguing ED findings like AFib and elevated lactate levels. The discussion delves into the causes of anemia and reveals a surprising EGD finding—gastric antral vascular ectasia (GAVE). Connections emerge between GAVE and systemic sclerosis, with insights on Raynaud's and antibody testing. A blend of complex medical concepts and engaging dialogue keeps listeners captivated throughout!
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Prioritize Immediate Dyspnea Tests
- Obtain oxygen, ECG, chest imaging, and vitals early for acute dyspnea to narrow life-threatening causes.
- Check for arrhythmia, hypoxia responsiveness to supplemental O2, and consider CTA if PE is suspected.
Type 2 Myocardial Injury Should Be Considered
- Multifactorial presentations (AF with RVR, anemia, hypoxemia) often produce type 2 myocardial injury rather than plaque rupture.
- Consider supply-demand mismatch causes before labeling NSTEMI as type 1 in the absence of ischemic chest pain or ST-elevation.
High Lactate Has Multiple Drivers
- A very high lactate can result from mixed mechanisms: severe anemia/hypoxemia (type A) plus inflammation, catecholamines, medications, or reduced clearance (type B).
- Interpret lactate within overall perfusion, oxygen-carrying capacity, ABG, and medication/AKI history before diagnosing shock.