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Pulmonary Medicine Department

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Presentation on theme: "Pulmonary Medicine Department"— Presentation transcript:

1 Pulmonary Medicine Department
Dyspnea Pulmonary Medicine Department Ain Shams University

2 Dyspnea, the sensation of breathlessness or inadequate breathing, is the most common complaint of patients with cardiopulmonary diseases.

3 Dyspnea - common complaint/symptom
“shortness of breath” or “breathlessness” Defined as abnormal/uncomfortable breathing Multiple etiologies - 2/3 of cases - cardiac or pulmonary etiology

4 Factors contribute to the production of dyspnea
Increase in the work of breathing Airway obstruction  pulmonary compliance Restricted chest expansion Increase in pulmonary ventilation  Dead space Severe hypoxemia Metabolic acidosis Hyperventilation syndrome Weakens of the respiratory muscles Multiple factors

5 Dyspnea How short of breath is the patient? Grade
When does it comes? Exertional/ Rest Does it comes in attack? Paroxysmal Does he have attacks of breathlessness at night? Does he have to sit up or can he sleep lying down? Orthopnea

6 Dyspnea Exertional Paroxysmal
Mild, moderate or severe. Paroxysmal Cardiac / bronchial asthma Others?(e.g. Carcinoid, Uremic asthma) Orthopnea (advanced CHF, COPD or asthma- massive ascites, late months of pregnancy) At rest

7 American Thoracic Society Grade of Breathlessness Scale
Degree Description None Not troubled with breathlessness except with strenuous exercise. 1 Slight Troubled by shortness of breath when hurrying on level ground or walking up a slight hill. 2 Moderate Walks slower than people of the same age on level ground because of breathlessness or has to stop for breath when walking at own pace on level ground. 3 Severe Stops for breath after walking approximately 100 yards or after a few minutes on level ground. 4 Very Severe Too breathless to leave the house or breathless when dressing and undressing.

8 Differential Diagnosis
Composed of four general categories Cardiac Pulmonary Mixed cardiac or pulmonary non-cardiac or non-pulmonary

9 Pulmonary Etiology COPD Asthma Restrictive Lung Disorders Pneumonia
Pneumothorax Pulmonary embolism

10 Cardiac Etiology CHF CAD Cardiomyopathy Valvular dysfunction
MI (recent or past history) Cardiomyopathy Valvular dysfunction Left ventricular hypertrophy Pericarditis Arrhythmias

11 Mixed Cardiac/Pulmonary Etiology
COPD with pulmonary HTN and/or cor pulmonale Deconditioning Chronic pulmonary emboli Pleural effusion

12 Asthma Cardiac Bronchial Age History Time of attack Duration
Usually old Usually young History Cardiac disease Chest disease Time of attack 2 hours after sleep Early morning Duration Minutes Up to hours Expectoration Minimal, but if APO occurs pink frothy Viscid mucoid (mucous pellet) O/E ± Valve lesion Fine basal crepitations ± Wheezes Inspiratory + expiratory sibilant ronchi TTT Diuretics Bronchodilators

13 Non cardiac or Non pulmonary Etiology
Metabolic conditions (e.g. acidosis) Pain Trauma Neuromuscular disorders Functional (anxiety, panic disorders, hyperventilation) Chemical exposure

14 Dyspnea Acute onset Dyspnea (1-2 hours) Pneumothorax Asthma
Pulmonary embolism APO FB

15 Dyspnea of slow onset Wheeze Interstitial lung disease Bronchiectasis
No Wheeze Occupational history ± Crackles ++ ± Pleurisy ± Hemoptysis Sputum++ ± Sputum Smoker Atopic? Interstitial lung disease Bronchiectasis Pulmonary embolism Asthma Pneumoconiosis COPD

16 Easily Performed Diagnostic Tests
Chest radiographs Electrocardiograph Screening spirometry

17 In cases where test results inconclusive
complete PFTs ABGs ECG Standard exercise treadmill testing/ or complete cardiopulmonary exercise testing Consultation with pulmonologist/cardiologist may be useful

18 ASTHMA  Work of breathing Hypoxemia


20 The bronchospasm characteristic of the acute asthmatic attack is typically reversible. It improves spontaneously or within minutes to hours of treatment

21 COPD Airway obstruction pulmonary compliance  Dead space
 Work of breathing Airway obstruction pulmonary compliance  pulmonary ventilation  Dead space Severe hypoxemia

22 Dominant Clinical Forms of COPD
Pulmonary emphysema Chronic bronchitis


24 Pneumothorax  pulmonary ventilation  Dead space Severe hypoxemia

25 Pulmonary Embolism Dead space (V/Q mismatch)
→  pulmonary ventilation

26 Questions ? Thank You

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