Chapter 3: Cardiopulmonary Symptoms

Chapter 3: Cardiopulmonary Symptoms

• Cardiopulmonary symptoms are a key area of study.
• A lecture outline covers various symptoms, including cough, sputum production, hemoptysis, shortness of breath (dyspnea), chest pain, dizziness and fainting (syncope), swelling of the ankles (dependent edema), fever, chills, night sweats, headache, altered mental status, personality changes, snoring, and gastroesophageal reflux.
• Learning objectives include: cough, sputum production, hemoptysis, dyspnea, chest pain, dizziness and fainting, swelling of ankles, fever, chills, night sweats, headache, altered mental status and personality changes, snoring, and gastroesophageal reflux.
• Signs and symptoms are categorized as subjective (patient description) and objective (measurable values, like heart rate, blood pressure, and respiratory rate).
• Assessing symptoms is important to determine severity and potential underlying causes, and to evaluate the effectiveness of treatment.
• Primary symptoms of cardiopulmonary disorders include cough, sputum production, hemoptysis, shortness of breath, and chest pain.

Cough

• A common symptom in pulmonary disease.
• A protective reflex triggered by stimulation of receptors in the pharynx, larynx, trachea, large bronchi, lung, and visceral pleura.
• Causes include inflammatory, mechanical, chemical, or thermal stimulation of cough receptors.
• History, physical examination, and chest X-ray (CXR) are key to determining the cause.
• Possible causes are listed in Table 3.1.

Sputum Production

• Secretions from the tracheobronchial tree, pharynx, mouth, sinuses, and nose.
• Phlegm is sputum from lungs and tracheobronchial tree.
• Components include mucus, cellular debris, microorganisms, blood, pus, and foreign particles.
• Normal sputum production is about 100 mL/day, moved upwards via cilia until swallowed.
• Abnormal sputum production (bronchorrhea) is more than 100 mL/day, caused by inflamed glands due to infection, smoking, or allergies.
• Characteristics for reporting abnormal sputum include color, quantity, consistency, odor, time of day, and presence of blood.
• Refer to Table 3.3 for presumptive sputum analysis.

Hemoptysis

• Expectoration of sputum containing blood, ranging from streaking to frank bleeding.
• Possible causes include bronchopulmonary, cardiovascular, hematologic, and systemic disorders, including Tuberculosis or fungal infections.
• Frequent causes are listed in Box 3.1.
• Description of hemoptysis includes amount (massive hemoptysis over 400 mL/3hrs or 600 mL/24 hrs) which is an emergency, bleeding type (streaky), sputum odor, color, and acuteness.

Shortness of Breath (SOB)

• A common and distressing respiratory/cardiac symptom.
• Important in limiting someone's ability to function.
• A cardinal symptom of cardiac disease.
• Types of SOB are defined as various symptoms, with different causes, as seen in table 3.6.
• Causes of dyspnea include those related to the respiratory system, such as lung disease or obstructive conditions, cardiac problems, chemical imbalances, neurological issues, psychological factors, and mechanical factors.
• Various scoring systems exist (e.g., visual analog scales, Borg scale, and questionnaires) for assessing dyspnea severity.
• Refer to Table 3.5 for the Modified Borg Scale.

Dyspnea

• A subjective experience of breathing discomfort.
• The components are sensory input (to the cerebral cortex), perception (e.g., "short-winded," feeling of suffocation), and the feeling of breathlessness.
• Different scoring systems exist to evaluate severity.
• Causes of dyspnea often result from a combination of physiological and psychological factors.

Chest Pain

• A common clinical presentation including causes such as cardiac ischemia, inflammatory disorders of the thorax and abdomen, musculoskeletal problems, trauma, anxiety, and referred pain from indigestion or a dissecting aortic aneurysm.
• It is a cardinal symptom of heart disease, including angina.
• Importance of quickly assessing the cause of pain as it may be an emergent condition.
• Pulmonary causes involve chest wall or parietal pleura, pleuritic pain, pain triggered by inspiratory movements, coughing, sneezing, hiccups, and changes in posture. Chest wall pain is often caused by pain in the intercostal and pectoral muscles and is often well localized.

Dizziness and Fainting (Syncope)

• A temporary loss of consciousness due to reduced cerebral blood flow and lack of oxygen, including causes such as thrombosis, embolism, atherosclerotic obstruction, pulmonary embolism, hypoxia/hypocapnia, and vasovagal syncope (most common).
• Orthostatic hypotension (sudden drop in blood pressure when standing), associated with illnesses like COPD, obesity, and alcohol use, is another cause.
• Tussive syncope (syncope from strong coughing) is often seen among those with COPD, obesity, smoking history and those who frequently consume alcohol.

Dependent Edema

• Soft tissue swelling from abnormal fluid accumulation, including anasarca (generalized edema) predominantly in the ankles and lower legs.
• Often caused by right or left heart failure, or conditions like cor pulmonale. A scale exists (Table 3.11) to evaluate pitting edema severity.

Fever, Chills, and Night Sweats

• Euthermia (normal body temperature) is 97°F to 99.5°F (36°C to 37.5°C).
• Fever (hyperthermia, pyrexia) can be sustained, remittent, intermittent, or relapsing.
• Common causes of fever include hot environments, dehydration, reactions to chemicals, drugs, hypothalamic damage, infections, and malignancies.

Headache, Altered Mental Status, and Personality Changes

• Headaches can be a symptom of cerebral hypoxia and hypercapnia in certain medical conditions like lung disease.
• Headache and altered mental status happen in the presence of hypercapnia (excess carbon dioxide in the blood) and cerebral hypoxia.
• Personality changes can be observed in advanced pulmonary disorders. These changes include forgetfulness, concentration difficulties, anxiety, and irritability.

Snoring

• Snoring is a serious concern when associated with apnea (temporary cessation of breathing) and should prompt evaluation for obstructive sleep apnea (OSA).
• The incidence of snoring, affected by age (especially prevalent in adults aged 50–59 years old, and slightly higher in females aged 60–64), is substantial (10–12% in children and 10–30% in adults.)
• Obesity is a primary risk factor for snoring, with other risk factors also being present.

Gastroesophageal Reflux Disease (GERD)

• Heartburn and regurgitation are common symptoms.
• Extraesophageal manifestations include laryngitis, asthma, chronic dry cough, chest pain, and dental erosion.
• GERD is diagnosed when a patient experiences these symptoms more than twice a week.
• Risk factors include obesity, cigarette smoking, and pregnancy.

Explore Chapter 3 focusing on various cardiopulmonary symptoms. This quiz covers essential symptoms such as cough, dyspnea, and chest pain, as well as their subjective and objective assessments. Enhance your understanding of how these symptoms relate to patient evaluation and treatment effectiveness.