Breathlessness Flashcards
What are the 6 common causes of breathlessness?
Asthma – Bimodal distribution – teens/young adults and later on in the 60s
COPD – associated with smoking
Heart failure – typically in older populations but also possible in younger individuals
Anemia – commonly ignored cause of breathlessness
Bronchiectasis – bronchial wall dilatation, thickening and mucus accumulation – cough up large quantities of sputum
Interstitial lung disease – problem with gas exchange, thickening of the alveolar wall
What is the classic presentation of asthma?
Classic asthma symptoms
1. Cough at night – indicates that the level of treatment is insufficient
2. Chest tightness upon performing exercise (some asthmas) + cold weather
3. History of eczema and hay fever – atopy/allergies with skin manifestations
What are the two main obstructive lung diseases?
Two main obstructive lung diseases – asthma and COPD
What is spirometry-reversibility testing
Performing spiromtery before and after administering a beta2-agonist (sympathetic mediated relaxation of airway smooth muscle)
Look particulalry at the changes in FEV1 following beta-agonist administration
Diagnosis standard - an increase in FEV1of 12 percent or more, accompanied by an absolute increase in FEV1of at least 200 mL
What is fractional exhaled nitric oxide - how is this used in asthma diagnosis?
Asthma is an autoimmune respiratory disease which causes airway inflammation - Nitric oxide is produced by respiratory epithelium in response to inflammation
Hence, NO can be measured in exhaled breath - Used secondary care/hospitals mainly as a diagnosis tool
Blood panel looking at eosinophil levels also possible.
What treatments are perscribed for asthma?
- Smoking cessation, including parents etc.
- Allergen avoidance
- Weight loss
- Reliever: beta2-agonist
- Preventer: inhaled corticosteroid - disease modifying therapy drugs – most patients are good on low dose of inhaled corticosteroids
Note - Asthma – is a disease that can be controlled with the correct treatment – frequent reliever is not a good sign
What is heart failure? What are some key presenting features of left and right ventricular failure?
Heart failure is due to impaired ability to fill with or eject blood
Left ventricular failure – pulmonary oedema
Right ventricular failure – lower limb oedema
Congestive heart failure – both
What is atrial natriuretic peptide?
Released from atria in response to stretch - This would occur with fluid overload
Wide range of effects
1. Natriuresis-sodium loss through the kidney
2. Diuresis - increased urine output
3. Lower blood pressure
Example
Left ventricle not ejecting enough blood, increases pressure and stretch in the left atrium - BNP secreted
How is natriuretic peptide used in heart failure diagnosis?
Brain-type Natriuretic Peptide (BNP, produced in atria) is used a biomarker of heart failure - used as a marker to prompt further investigations
If elevated diagnosis confirmed by echocardiography
When investigating for suspected heart failure, what is the echocardiogram used for?
Looking at the echocardiography-ejection fraction
Compares the amount of blood in the left ventricle before and after each contraction
What is the typical presentation of idiopathic pulmonary fibrosis?
- Breathless - low oxygen saturation
- Smoking
- Finger clubbing
- Cyanosis - blue discolouration
- Inspiratory crackles - lower lobes
What investigations are performed for idiopathic pulmonary fibrosis?
Chest X-ray - Reticular pattern of shadowing in lung bases - net like shadowing on lung peripheries + cause contours of heart to become more shaggy
CT scan chest - Classic honeycomb lung of fibrosis
Pulmonary function tests - Restrictive pulmonary deficit - Reduced lung volumes- FEV1/FVC ratio normal or high - resulting in reduced gas transfer
What is a cause of breathlessness that is typically forgotten?
Anemia - perform blood tests to rule it out
