Presentation on theme: "Dyspnea Pulmonary Medicine Department Ain Shams University"— Presentation transcript:
Dyspnea Pulmonary Medicine Department Ain Shams University http://telemed.shams.edu.eg/moodle5
Dyspnea,Dyspnea, the sensation of breathlessness or inadequate breathing, is the most common complaint of patients with cardiopulmonary diseases.
Dyspnea - common complaint/symptomDyspnea - common complaint/symptom “shortness of breath” or “breathlessness”“shortness of breath” or “breathlessness” Defined as abnormal/uncomfortable breathingDefined as abnormal/uncomfortable breathing Multiple etiologies -Multiple etiologies - 2/3 of cases - cardiac or pulmonary etiology2/3 of cases - cardiac or pulmonary etiology
Factors contribute to the production of dyspnea Increase in the work of breathingIncrease in the work of breathing Airway obstructionAirway obstruction pulmonary compliance pulmonary compliance Restricted chest expansionRestricted chest expansion Increase in pulmonary ventilationIncrease in pulmonary ventilation Dead space Dead space Severe hypoxemiaSevere hypoxemia Metabolic acidosisMetabolic acidosis Hyperventilation syndromeHyperventilation syndrome Weakens of the respiratory musclesWeakens of the respiratory muscles Multiple factorsMultiple factors
Dyspnea How short of breath is the patient? GradeHow short of breath is the patient? Grade When does it comes? Exertional/ RestWhen does it comes? Exertional/ Rest Does it comes in attack? ParoxysmalDoes it comes in attack? Paroxysmal Does he have attacks of breathlessness at night?Does he have attacks of breathlessness at night? Does he have to sit up or can he sleep lying down? OrthopneaDoes he have to sit up or can he sleep lying down? Orthopnea
Dyspnea ExertionalExertional Mild, moderate or severe.Mild, moderate or severe. ParoxysmalParoxysmal Cardiac / bronchial asthmaCardiac / bronchial asthma Others?(e.g. Carcinoid, Uremic asthma)Others?(e.g. Carcinoid, Uremic asthma) Orthopnea (advanced CHF, COPD or asthma- massive ascites, late months of pregnancy)Orthopnea (advanced CHF, COPD or asthma- massive ascites, late months of pregnancy) At restAt rest
7 American Thoracic Society Grade of Breathlessness Scale GradeDegreeDescription 0None Not troubled with breathlessness except with strenuous exercise. 1Slight Troubled by shortness of breath when hurrying on level ground or walking up a slight hill. 2Moderate 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. 3Severe 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.
Differential Diagnosis Composed of four general categoriesComposed of four general categories CardiacCardiac PulmonaryPulmonary Mixed cardiac or pulmonaryMixed cardiac or pulmonary non-cardiac or non-pulmonarynon-cardiac or non-pulmonary
Cardiac Etiology CHFCHF CADCAD MI (recent or past history)MI (recent or past history) CardiomyopathyCardiomyopathy Valvular dysfunctionValvular dysfunction Left ventricular hypertrophyLeft ventricular hypertrophy PericarditisPericarditis ArrhythmiasArrhythmias
Asthma CardiacBronchial Age Usually old Usually young History Cardiac disease Chest disease Time of attack 2 hours after sleep Early morning Duration DurationMinutes 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 TTTDiureticsBronchodilators
Non cardiac or Non pulmonary Etiology Metabolic conditions (e.g. acidosis)Metabolic conditions (e.g. acidosis) PainPain TraumaTrauma Neuromuscular disordersNeuromuscular disorders Functional (anxiety, panic disorders, hyperventilation)Functional (anxiety, panic disorders, hyperventilation) Chemical exposureChemical exposure
In cases where test results inconclusiveIn cases where test results inconclusive complete PFTscomplete PFTs ABGsABGs ECGECG Standard exercise treadmill testing/ or complete cardiopulmonary exercise testingStandard exercise treadmill testing/ or complete cardiopulmonary exercise testing Consultation with pulmonologist/cardiologist may be usefulConsultation with pulmonologist/cardiologist may be useful