dyspnea by alrepat

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									It is a term of a Greek root:
Dys = painfull, difficult
Pnea = breathing

*Definition:

It is an abnormally uncomfortable awareness of breathing (witch is
subjective).

*Causes:

-Cardiac -Psychogenic - Obesity
-Respiratory -Anaemia
-****bolic -Fever

*Mechanism &Physiological basis:

Any increase in respiratory work or load due to:
↑ Ventilatory rate or
↓ Ventilatory capacity → DYSPNEA

This is through stimulation of:
1-intrathoracic (J) receptors (via vagus).
2-afferent nerves in respiratory muscles, chest wall, skeletal muscles
and joints.
3-chemoreceptors in the brain, aortic arch and carotid bodies.
4-higher centers.
5-phrenic nerves (some afferent fibers).

*Patterns of dyspnea:

Orthopnea: dyspnea in supine position.
Platypnea: dyspnea in upright position.
Trepopnea: dyspnea in lateral position.




*Respiratory causes:

-Laryngeal: spasm or oedema
-Tracheobronchial: F.B, secretions, tumours, C.O.P.D.
-Parynchematous lung diseases: consolidation, fibrosis or collapse.
-Pleural: effusion, pneumothorax.
-Chest wall: kyphoscoliosis, obesity or trauma.


*Cardiac causes:

Left ventricular failure
Mitral stenosis

*****bolic causes:

-D.K.A.
-Lactic acidosis.
-Uremia.
-Salicelate toxicity.

*GRADING&QUANTITATION:

Dyspnea on exertion:

Mild →on severe exertion
Moderate →on moderate exertion
Severe →on mild exertion

Dyspnea on rest:
Orthopnea
P.N.D
Cardiac asthma


*An approach to the differential diagnosis of the patient with chronic
exertional dyspnea:

*C.O.P.D:

History:
-history of exertional dyspnea over months or years.
-↓ exercise capacity by time.
-chronic cough & expectoration.
-recurrent attacks of acute bronchitis.
-wheezes especially with exercise.
-if patient developed core pulmonale→ orthopnea, nocturnal dyspnea,
ankle swelling.

On examination:
Cyanosis,wheezes,pursing of lips,indrawing of I.C muscles,
barell chest.
C.X.R→hyperinflation, bullae
A.B.G→hypoxia, hyercapnea
spirometry→↓ FEV1

*HEART DISEASES:
-history of hypertension (headache, blurring of vision,…).
-anginal pain (retrosternal, radiating to shoulder.jaw,..).
-family history of heart diseases.
On examination:
Cardiomegaly
↑J.V.P
Murmurs
C.X.R→cardiomegaly

*INTERSTITIAL LUNG DISEASES:
-History of exposure to dust, silica, birds, occupational asthma
On examination:
↓ Vital capacity
C.X.R→fibrosis


*An approach to the patient with acute severe dyspnea:

-It is a medical emergency – dramatic presentation
-rapid history&examination
-investigations include: CXR, ECG, ABG, and ECHO.

History:

-similar attacks, previous diseases.
-associated symptoms:
Cardiovascular→chest pain, palpitation, orthopnea, sweating.

Respiratory→cough, haemoptysis, wheezes, stridor.

Provocating factors:
Infection
Drug intake
Smoking
Allergens: dust, pullens, birds.

Examination:

Assessment of the severity of the case by:
-level of consciousness.
-air way potency.
-ability to speake.
-pulse, ABP.
-cyanosis, clubbing, polythycemia.
-urticaria, angioedema (anaphylaxis).
-respiratory rate, pattern of breathing.
-wheezes, crepitation, ↓breath sound.
-hyperresonence, dullness.

								
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