Ch 47e: Dyspnea

Question 1

When this text talks about impaired ventilatory pump function, what is meant by this phrase?

Answer 1

It refers to decreased compliance of the chest wall.

Question 2

Nocturnal dyspnea suggests…

Answer 2

…CHF or asthma.

Question 3

What is platypnea?

Answer 3

dyspnea in the upright position that is relieved in the supine position

Question 4

What two conditions should be considered when a patient complains of platypnea?

Answer 4

left atrial myxoma or hepatopulmonary syndrome

Question 5

What kind of test can be done to distinguish between cardiac and respiratory system dyspnea?

Answer 5

A cardiopulmonary exercise test

Question 6

The extent to which fluid accumulates in the interstitium of the lungs depends on…

Answer 6

…the balance of hydrostatic and oncotic forces within the pulmonary capillaries and the surrounding tissues.

Question 7

Hydrostatic pressure favors movement of fluid from…

Answer 7

…the capillary into the interstitium.

Question 8

Oncotic pressure is determined by what?

Answer 8

the protein concentration in the blood

Question 9

Oncotic pressure favors…

Answer 9

…movement of fluid into the vessel.

Question 10

In noncardiogenic pulmonary edema, lung water increases due to damage of the pulmonary capillary lining with consequent leakage of…

Answer 10

…proteins and other macromolecules into the tissue. Fluid then follows the protein as oncotic forces shift.

Question 11

Keep in mind that it is possible for patients to have a combination of ___________ and ______________ pulmonary edema.

Answer 11

cardiogenic and noncardiogenic

Question 12

Table 47e-3 lists the common causes of noncardiogenic pulmonary edema, sorted into 3 categories:

Answer 12

1.) direct injury to the lung
2.) hematogenous injury to the lung
(hee-ma-TOJ-e-nus)
3.) possible lung injury plus elevated hydrostatic pressures

Question 13

What 6 common causes of noncardiogenic pulmonary edema cause direct injury to the lung? (direct meaning via the airways)

Answer 13

chest trauma, pulmonary contusion
aspiration
smoke inhalation
pneumonia
oxygen toxicity
pulmonary embolism, reperfusion

Question 14

What 7 common causes of noncardiogenic pulmonary edema cause hematogenous injury to the lung?

Answer 14

sepsis
pancreatitis
nonthoracic trauma
leukoagglutination reactions
multiple transfusions
intravenous drug use (e. g. heroin)
cardiopulmonary bypass

Question 15

What 3 common causes of noncardiogenic pulmonary edema cause possible lung injury plus elevated hydrostatic pressures?

Answer 15

high-altitude pulmonary edema
neurogenic pulmonary edema
reexpansion pulmonary edema

Question 16

What is the primary difference between the hypoxemia of cardiogenic pulmonary edema compared to the hypoxemia of noncardiogenic pulmonary edema?

Answer 16

The hypoxemia of cardiogenic pulmonary edema is due largely to V. /Q mismatch and responds to the administration of supplemental oxygen.
In contrast, hypoxemia in noncardiogenic pulmonary edema is due primarily to intrapulmonary shunting and typically persists despite high concentrations of inhaled oxygen.