Chronic Dyspnoea Flashcards
What is the definition of dyspnoea?
Undue awareness of ones own breathing due to a change in either rate, depth or work of breathing (WOB)
What changes can lead to dyspnoea?
Changes in 02,CO2 or pH
Lung perfusion
Ventilation
Diffusion related issues (Interstitial lung disease)
Pump failure (spine, diaphragm, muscles)
Exercise
Pregnancy
What is an example of a disease which limits lung perfusion leading to dyspnoea?
Pulmonary Embolism
What is a common ventilation issue which can lead to dyspnoea?
COPD
What are some issues with muscles that can lead to dyspnoea?
Myasthenia gravis
Phrenic nerve palsy
Guillain barre syndrome
What are some systemic causes of dyspnoea?
CKD
Heart failure (leading to pulmonary oedema
What is orthopnoea?
Breathlessness on lying flat
What are some causes of Orthopnoea?
What is a good question to ask to gauge the severity?
Congestive heart failure
Severe COPD
How many pillows do you use to sleep at night
What is the term used to describe waking up in the night coughing due to fluid in lungs?
Paroxysmal nocturnal dyspnoea
What can cause paroxysmal nocturnal dyspnoea?
Congestive heart failure
What is platypnoea orthodeoxia syndrome?
When patient is comfortable lying down but becomes breathless with dropping 02 sats when they stand up
What conditions does Platypnoea orthodeoxia syndrome suggest?
AV shunting (Pulmonary AV fistula)
Patent Foramen Ovale
What is trepopnoea?
Laying on one side causes breathlessness
What is trepopnoea suggestive of?
Unilateral. Lung disease
Compression related to big tumour
Pleural effusion
Aneurysm of aorta
Large hiatus hernia
What is bendopnoea?
What can you ask a patient to gauge?
SOB on bending down
Ask if the can tie their shoe laces
What are some causes of bendopnoea?
COPD
Congestive heart failure
Pleural effusion
What is the definition of chronic breathlessness?
Develops over weeks to months
What is the definition of acute breathlessness?
Develops over minutes to a few hours
What is the definition of subacute breathlessness?
Develops over several hours to days
List as many causes of chronic breathlessness as possible:
Obstructive - COPD, asthma, Bronchiectasis, cystic fibrosis, obstructive sleep apnoea
Restrictive - intersitial lung disease (pulmonary fibrosis, silicosis, asbestosis, pneumoconiosis, byssinosis)
Mesothelioma
TB
Lung cancer
Chronic. PE
Primary pulmonary hypertension
Congestive heart failure
Cardiac issues
Kyphoscoliosis
Renal failure
DKA
Anaemia.
What is byssinosis?
Interstitial lung disease due to inhalation of cotton
What is the most common cardiac issue in older people that causes chronic dyspnoea?
Aortic stenosis
Mitral stenosis
Hx:
What is important to ask about the presenting complaint for chronic breathlessness?
Duration
Onset
Severity (functional impairment)
Factors worsening or alleviating
Hx:
What it’s important to understand from a patients Social history with chronic breathlessness?
Smoking
Alcohol
Physical activity (exercise TOLERANCE)
Travel history (TB or other travel related infections)
Pets (Bird fanciers lung)
Occupation (asbestosis, pneumoconiosis, silicosis, byssinosis)
Hx:
What are some important associated features we would want to ask about which might aid a diagnosis for a cause for chronic breathlessness?
Chest pain
Palpitations
Syncope
Weight loss
Fever
Sputum
Cough
Muscle weakness
Hx:
What are some drugs that can contribute to chronic dyspnoea?
Beta blockers
Amiodarone (amiodarone immunities)
Nitrofurantoin
Methotrexate
Bleomycin
What is paradoxical breathing?
When the chest falls anal abdomen rises with inhalation
What does paradoxical breathing suggest?
Diaphragmatic paralysis
Severe muscle weakness (severe asthma exacerbation, COPD exacerbation, myasthenia gravis)
What is the NICE criteria for a CXR to query a lung cancer?
Over 40yr or ever smoked with unexplainable symptoms:
-cough
-fatigue
-SOB
-chest pain
-weight loss
What values on spirometry would you expect to find for obstructive lung disease?
FEV1:FVC ratio < 0.7
What values on spirometry would you expect to find for restrictive lung disease?
FEV1:FVC ratio > 0.8
What is interstitial lung disease?
Conditions characterised by inflammation of alveolar epithelium and interstitium leading to fibrosis
What are some causes of interstitial lung disease?
Idiopathic pulmonary r fibrosis
Hypersensitivity pneumonic it’s
Sarcoidosis
Connective tissue disease related pulmonary fibrosis
Drug induced
Occupational (silicosis, asbestosis, pneomconiosis, byssinosis)
What investigations would you do on someone with chronic breathlessness?
FBC
U+Es
LFTs
ECG
Thyroid function test
CXR
Abdo US. (Ascites? Liver. Cirrhosis?)
Peak expiratory flow rate
Spirometry
What is an example of a measure/scale of breathlessness?
MRC scale of dyspnoea
How is the MRC (medical research council scale for dyspnoea graded?
1-5
What is grade 1 of the MRC scale of dyspnoea?
Not troubled by breathlessness expect on strenuous exercise
What is grade 2 of the MRC scale of dyspnoea?
Short of breath when hurrying on the level or walking up a slight hill
What is grade 3 of the MRC scale of dyspnoea?
Walks slower than most people on the level
Stops after a mile or so or stops after 15miins walking at own pace
What is grade 4 of the MRC scale of dyspnoea?
Stops for breath after walking about 100 yards or after a few minutes on level ground
What is grade 5 of the MRC scale of dyspnoea?
Too breathless to leave the house or breathless while undressing
What are some other scales that we can use to assess breathlessness?
CPET (cardiopulmonary exercise testing)
6 minute walking distance and shuttle walk
