7.8.2013(dyspnea) Flashcards
Cause of chest tightness or constriction
Bronchoconstriction
Interstitial Edema due to heart failure
Metaboceptors are located in
Skeletal muscles
Cannot get a deep breath,causes
Hyperinflation
Decreased tidal volume(fibrosis,chest wall restriction)
Increased work or effort of breathing,causes
Obstruction
Neuromuscular causes
Air hunger,causes
CHF
Pulmonary embolism
Obstruction
Mechanism of Dyspnea in COPD
Increased work of breathing
Hypoxemia
Acute Hypercapnia
Mechanism of Dyspnea in cardiogenic pulmonary Edema
Increased work of breathing Air hunger Hypoxemia Stimulation of pulmonary receptors Stimulation of vascular receptors Metaboceptors
Mechanism of Dyspnea in non cardiogenic pulmonary Edema
Similar to CPE except that metaboceptors and stimulation of vascular receptors donot play a role
Mechanism of Dyspnea in asthma
Increased work of breathing Air hunger Hypoxemia Acute Hypercapnia Stimulation of pulmonary receptors
Similar mechanisms in ILD
Cause of Dyspnea in pulmonary vascular disease
Air hunger
Hypoxemia
Stimulation of pulmonary vascular receptors
Mechanism of Dyspnea in Anemia
Stimulation of metaboceptors
Causes of Dyspnea in pleural effusion
Increased work of breathing
Atelectasis stimulating pulmonary receptors
Cause of Dyspnea in obesity
Impaired ventilatory function due to reduced chest wall compliance
Orthopnea,causes
CCF
obesity
GERD induced asthma
Nocturnal Dyspnea
Asthma
CCF
Acute intermittent Dyspnea
Myocardial ischemia
Pulmonary embolism
Bronchospasm
Chronic persistent Dyspnea
COPD
ILD
chronic thromboembolic disease
Causes of platypnea
Left atrial myxoma
Hepatopulmonary syndrome
History taking in Dyspnea
Quality
Timing
Positional variation
Persistent Vs intermittent
Signs of increased work of breathing
Supraclavicular retraction
Use of accessory muscles of ventilation
Tripod position
Paradoxical movement of abdomen during respiration is a sign of
Diaphragmatic weakness
Prominent pulmonary vasculature in upper zones
Pulmonary venous hypertension
Enlarged central pulmonary arteries
Pulmonary artery hypertension
Distinguishing cardiovascular and respiratory cause of Dyspnea
Exercise cardiopulmonary testing
Experimental interventions in Dyspnea
Cold air on face
Chest wall vibration
Inhaled frusemide
Findings pointing to respiratory cause in cardiopulmonary exercise test
Pts achieves predicted maximal ventilation
Increase in dead space
Hypoxemia
Bronchospasm
Findings pointing to CVS cause in cardiopulmonary exercise test
HR is more than 85% of max
Ischemic changes in ECG
increased or decreased blood pressure
Fall in O2 pulse
O2 pulse
Oxygen consumption/HR
indicator of stroke volume
Chest X ray in pulmonary Edema
Peribronchial thickening
Prominent vascular markings in upper lung zones
Kerley B lines
Non cardiogenic pulmonary Edema due to direct lung injury
Chest trauma Aspiration Smoking Pneumonia Oxygen toxicity Pulmonary embolism,reperfusion
Hematogenous causes of Noncardiogenic pulmonary Edema
Sepsis Pancreatitis Non thoracic trauma Leukoagglutination reactions Multiple transfusions IV drug use(heroin) Cardiopulmonary bypass
Noncardiogenic pulmonary Edema due to lung injury and elevated hydrostatic pressures
High altitude pulmonary Edema
Neurogenic pulmonary Edema
Reexpansion pulmonary Edema
Diff btw cardiogenic and Noncardiogenic pulmonary Edema
Pleural effusions are not common
Normal heart size
Uniform pulmonary infiltrates
Doesnot respond to supplemental oxygen as it is due to intra pulmonary shunting
Cause of Dyspnea in DKA,renal insufficiency
Increase in H+ conc
Cause of sensation of air hunger
Chemoreceptor stimulation
Cause of sensation of increased respiratory effort
Central respiratory motor command
In which type Dyspnea is more?
Restrictive or obstructive
No such difference
Scales for measuring Dyspnea
MRC
OCD(oxygen cost diagram)
Rx that relives Dyspnea by reducing metabolic load
Exercise training
Supplemental oxygen
How oxygen relieves Dyspnea ?
Reduces metabolic load
Decreases central drive
