Dyspnea PDF

Dyspnea  Definition : Dyspnea (breathlessness) is the subjective sensation of shortness of breath , which may be discomfort or an abnormal awareness of breathing. Dyspnea is the most prominent symptom of pulmonary diseases ,but also can be seen as a primary manifestation of nonpulmon...

Dyspnea  Definition : Dyspnea (breathlessness) is the subjective sensation of shortness of breath , which may be discomfort or an abnormal awareness of breathing. Dyspnea is the most prominent symptom of pulmonary diseases ,but also can be seen as a primary manifestation of nonpulmonary disorders , such as cardiac diseases. Types of Dyspnea Orthopnea PND Trepopnea Platypnea Exertional dyspnea  Causes of dyspnea : dyspnea classify into acute and chronic dyspnea : Causes of acute dyspnea : 1. Cardiovascular causes : acute pulmonary oedema. 2. Respiratory causes : ✓ Acute severe asthma ✓ Acute exacerbation of chronic obstructive pulmonary disease (COPD) ✓ Pulmonary embolism ✓Pneumonia ✓Pnemothorax ✓Acute respiratory distress syndrom(ARDS) ✓Lobar collapse ✓Laryngeal oedema (e.g. anaphylaxis) ✓Inhaled foreign body 3. Others ✓ Psychogenic hyperventilation (e.g.anxiety) ✓ Acidosis  Causes of chronic (exersional)dyspnea: 1. Ca r d i o va sc ula r c a u ses : ✓ Chronic heart failure ✓ Myocardial ischemia 2. Resp i r a t o ry c a u ses ✓ COPD / asthma ✓ Interstitial lung disease ✓ Bronchogenic carcinoma ✓ Chronic pulmonary thromboembolism ✓ Large pleural effusion 3. O t h er s : ✓ Severe anemia ✓ Obesity  Approach to patient with dyspnea : The approach for any patient with breathlessness will depend on careful history and clinical examination , ECG ,CXR and other lab and imaging techniques according to each case. Approach to patient with chronic dyspnea : ✓ The cause is usually apparent from clinical history ✓ Keys questions include : 1. How is your breathing at rest or during sleep time ? 2. How much you can do on a good day ? (the exercise capacity) ✓ Document the distant the patient can walk on the level. Also the capacity to climb inclines and stairs. 3. Any breathing problem in childhood or at school ? Any history of atopic allergy? ✓ The presence of these will increase the likelihood of asthma. 4. What are the other symptoms along with breathlessness ? ✓ These symptoms include : - Cough (dry or productive) - Any wheezing - Pleuritic chest pain ,epically if it occurs in more than one site over time = chronic thromboemolic diseases. - Morning headache = CO2 retention  Approach to patient with acute dyspnea : Acute severe breathlessness is the most common and dramatic medical emergencies The history and rapid , but careful clinical examination can suggest a diagnosis, that can be confirmed by CXR and ECG. History points : 1. Rate of onset and severity of breathlessness 2. Any associated cardiac symptoms: chest pain, palpitation , sweating and nausea. 3. Any respiratory symptoms: cough, wheezing , haemoptysis. 4. In children : always consider inhalation of a foreign or acute epiglottitis.  Clinical examination : the following should be assessed and documented immediately: 1. Vital signs 2. The level of consciousness 3. The degree of central cyanosis 4. Patency of upper airways 5. Ability to speak (in single ward or sentences) 6. Cardiovascular status examination 8. Respiratory examination. 9. Leg swelling : bilateral or unilateral Treatment of acute breathlessness: 1. Specific treatment is directed to the underlying cause. 2. Endotracheal intubation should be considered in case of impairment of the level of consciousness or in the case of severe respiratory acidosis.