Presentation on theme: "Pulmonary Medicine Department"— Presentation transcript:
1 Pulmonary Medicine Department DyspneaPulmonary Medicine DepartmentAin Shams University
2 Dyspnea,the sensation of breathlessness orinadequate breathing, is the most commoncomplaint of patients with cardiopulmonarydiseases.
3 Dyspnea - common complaint/symptom “shortness of breath” or “breathlessness”Defined as abnormal/uncomfortable breathingMultiple etiologies -2/3 of cases - cardiac or pulmonary etiology
4 Factors contribute to the production of dyspnea Increase in the work of breathingAirway obstruction pulmonary complianceRestricted chest expansionIncrease in pulmonary ventilation Dead spaceSevere hypoxemiaMetabolic acidosisHyperventilation syndromeWeakens of the respiratory musclesMultiple factors
5 Dyspnea How short of breath is the patient? Grade When does it comes? Exertional/ RestDoes it comes in attack? ParoxysmalDoes 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.ParoxysmalCardiac / bronchial asthmaOthers?(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 DegreeDescriptionNoneNot troubled with breathlessness except with strenuous exercise.1SlightTroubled by shortness of breath when hurrying on level ground or walking up a slight hill.2ModerateWalks 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.3SevereStops for breath after walking approximately 100 yards or after a few minutes on level ground.4Very SevereToo breathless to leave the house or breathless when dressing and undressing.
8 Differential Diagnosis Composed of four general categoriesCardiacPulmonaryMixed cardiac or pulmonarynon-cardiac or non-pulmonary
12 Asthma Cardiac Bronchial Age History Time of attack Duration Usually oldUsually youngHistoryCardiac diseaseChest diseaseTime of attack2 hours after sleepEarly morningDurationMinutesUp to hoursExpectorationMinimal, but if APO occurs pink frothyViscid mucoid (mucous pellet)O/E± Valve lesionFine basal crepitations± WheezesInspiratory + expiratory sibilant ronchiTTTDiureticsBronchodilators
13 Non cardiac or Non pulmonary Etiology Metabolic conditions (e.g. acidosis)PainTraumaNeuromuscular disordersFunctional (anxiety, panic disorders, hyperventilation)Chemical exposure
16 Easily Performed Diagnostic Tests Chest radiographsElectrocardiographScreening spirometry
17 In cases where test results inconclusive complete PFTsABGsECGStandard exercise treadmill testing/ or complete cardiopulmonary exercise testingConsultation with pulmonologist/cardiologist may be useful