Dyspnea in the elderly: cardiac or pulmonary?

Compare the chest film with previous films, if possible. Changes in heart size and interstitial and vascular markings can thus be seen more readily, as can air trapping; this also aids in differentiation of acute from chronic changes. A Holter monitor study should be obtained if dyspnea occurs irregularly, has acute onset and termination, or is associated with dizziness or syncope; or if the resting ECG shows frequent premature atrial contractions, premature ventricular contractions, bradycardia, or periods of advanced heart block.