CSI 7 Flashcards
What are the 4 main causes of breathlessness?
- lung condition
- heart condition
- anxiety
- being unfit
If you get breathless everyday you may be diagnosed with one of these causes
In what ways can lung conditions lead to breathlessness?
- cause the airways to become inflamed and narrowed
- fill the airways with phlegm=harder for air to ove in and out of the lungs
- make lung stiff and less elastic so its harder for them to expand and fill with air
Which Lung conditions cause long term (chronic) breathlessness?
- Chronic obstructive Pulmonary disease(COPD)
- asthma
- interstitial lung disease (ILD), including pulmonary fibrosis
- bronchiectasis
- industrial or occupational lung diseases such as asbestosis, which is caused by being exposed to asbestos
- lung cancer
What lung conditions cause short term (Acute) breathlessness?
- a flare-up of asthma or COPD
- a pulmonary embolism or blood clot on the lung
- a lung infection such as pneumonia or tuberculosis
- a pneumothorax or collapsed lung
- a build-up of fluid in your lungs or the lining of your lungs – this might be because your heart is failing to pump efficiently or may be because of liver disease, cancer or infection
What can lead to heart failure?
problems in rhythm, valves, or cardiac muscles
Why would heart failure cause breathlessness?
- because the heart is not able to increase its pumping strength in response to exercise
- or because the lungs become congested and filled with fluid
When is breathlessness due to heart failure the worst?
at night or when asleep because lying down can make it worse
What heart conditions can cause acute breathlessness?
- heart attack
- abnormal heart rhythm(miss or beat or palpitations)
Why would anxiety lead to breathlessness?
-anxious due to stress=body prepares for action=breath faster and tense muscles
What are the reasons for anxiety?
-general stress
-PHYSICAL HEALTH IS POOR- you could get anxious if you fell like you’re not in control of your condition
-SYMPTOMS-of a condition might make you fell anxious
-
What symptoms are similar to anxiety?
- Breathlessness
- tightness in chest
- getting tired easily
What happens during a panic attack?
- body normal response is exaggerated and you get a rapid build up of physical responses
- As your body tries to take in more oxygen breathing quickens and body releases hormones so your heart beats faster and your muscles tense
What symptoms do you experience during a panic attack?
- have a pounding heart
- feel faint
- sweat
- feel sick
- have shaky limbs
- feel you’re not connected to your body
- feel like you cant breathe
Why would you experience breathlessness if you are unfit?
Muscles get weaker=need more oxygen to work=more breathless you feel
Why would being an unhealthy weight make you fell breathless?
UNDERWEIGHT- breathing muscles are weaker
OVERWEIGHT:
- more effort to breathe and move around
- more weight around the abdomen restricts how much your lungs can move
What is obesity hypoventilation syndrome?
- People who are severely overweight have it
- when poor breathing leads to lower oxygen levels and higher carbon dioxide levels in their blood
What are other causes of long term breathlessness?
- smoking
- conditions that affect how your muscles work, such as muscular dystrophy, myasthenia gravis or motor neurone disease
- postural conditions that alter the shape of your spine, and affect how your ribs and how your lungs expand. For example scoliosis and kyphosis
- anaemia, when a lack of iron in the body leads to few red blood cells
- kidney disease
- thyroid disease
Why can early diagnosis of breathlessness be beneficial?
-you may feel less anxious and therefore less breathless if you have a diagnosis
What will happen when you go see your doctor about your breathlessness?
They’ll show you an MRC (Medical Research Council) breathlessness scale to help describe how breathless you get
What is MRC breathlessness scale based on?
- Does not consider how you think or feel about getting out of breath
- It shows what your breathlessness stops you doing
Describe the Grades on the MRC breathlessness scale?
1-Not troubled by breathlessness except on strenuous exercise
2- Short of breath when hurrying on the level or walking up a slight hill
3- Walks slower than most people on the level, stops after a mile or so, or stops after 15 minutes walking at own pace
4- Stops for breath after walking about 100 yards or after a few minutes on level ground
5-Too breathless to leave the house, or breathless when undressing
What should you tell your doctor when going in for an appointment about breathlessness?
▶︎what you used to be able to do that you can’t do any more
▶︎what people of your age around you do that you think you should be able to do
▶︎what your personal goals are for your day-to-day activity
If you have a phone or camera with you how could this help you at your doctors appointment?
record the sort of activities that make you out of breath so you can show your doctor what it looks/sounds like
What questions will the doctor ask?
▶︎How long have you been feeling breathless and how quickly did it come on?
▶︎Does it come and go or is it there all the time?
▶︎Is there any pattern to your breathlessness?
▶︎Does it start or get worse at any particular time of day?
▶︎Does it come on or get worse when you lie flat?
▶︎Does anything bring it on? For example, pollen, pets or medication?
▶︎Do you smoke?
▶︎Do you also have a cough, or bring up phlegm?
▶︎Do you get chest pain, palpitations or ankle swelling?
▶︎How active are you usually?
▶︎What’s your job or occupation?
▶︎Is your breathlessness related to certain times at work?
▶︎Do you have a history of heart, lung or thyroid disease or of anaemia?
▶︎Have you made any changes in your life because of your shortness of breath?
▶︎Do you feel worried or frightened, depressed or hopeless?
▶︎What have you done to help you cope with the way you’re feeling?
What tests will you doctor do to help diagnose whats causing your breathlessness?
- breathing and LUNG FUNCTION tests
- check BREATHS PER MIN, listen to your chest, and look and feel how your chest moves as you breathe
- heart rate and rhythm
- check if FLUID is building up in your ankles or lungs
- BLOOD PRESSURE and TEMPERATURE
- height, weight, waist and body mass index
- examine your head, neck and armpits to see if your LYMPH GLANDS SWOLLEN
- look at your eyes, nails, skin and joints
- check your BLOOD OXYGEN levels with a PULSE OXIMETER
- might ask you a short questionaire if they spot that you are anxious or depressed
For which tests will you be referred to a hospital for?
- CHEST x-ray
- SPIROMETRY TEST
- ECG(if breathlessness is intermittent you might be asked to wear a portable recorder for 24 hours or 7 days)
- ECHOCARDIOGRAM(non invasive ultrasound of the heart)
- blood tests to detect anaemia, allergies or any thyroid, liver, kidney or heart problems
How long will it take to get a diagnosis?
-time because all possible causes must be considered and you may need to repeat tests and try various treatment before the cause is identified
What investigations should be arranged when diagnosis for breathlessness cannot be established by clinical features alone?initi
◾Chest radiography - to look for signs of heart failure and pulmonary pathology (including pleural effusion).
◾Electrocardiography (ECG) - to look for signs of heart failure, arrhythmia, and pulmonary embolism.
◾Spirometry - to look for signs of obstructive airway disease or a restrictive pattern associated with interstitial lung disease (such as idiopathic pulmonary fibrosis, sarcoidosis, pneumoconiosis, or extrinsic allergic alveolitis).
◾Full blood count - to check for anaemia.
◾Urea and electrolytes, and random blood glucose level - to test for renal failure and diabetes as causes of metabolic acidosis and breathlessness.
◾Thyroid function tests - to detect thyroid disease as a cause of breathlessness.
◾B-type natriuretic peptide (BNP) or N-terminal pro-B-type natriuretic peptide (NTproBNP) - to assess for heart failure.
What should you do if the investigations you arranged do not identify any of the causes of breathlessness?
◾Reassess for risk factors and clinical features of pulmonary embolism. If this is suspected, arrange urgent referral for further investigations
What results would lead you to suspect asthma or COPD?
Airway obstruction is confirmed by a forced expiratory volume in 1 second (FEV1) less than 80% of the predicted value and FEV1/forced vital capacity (FVC) ratio less than 70%.
How would you distinguish between asthma and COPD?
◾Smoking history - almost always present in people with COPD.
◾Age - usually older than 35 years of age for COPD.
◾Chronic productive cough - common with COPD, uncommon with asthma.
◾Breathlessness - progressive with COPD, variable with asthma.
◾Variability of symptoms - common with asthma, uncommon with COPD.
◾Night time wakening with wheeze and breathlessness - common with asthma, uncommon with COPD.
What should you consider if asthma and COPD cannot be distinguished between?
per day, for 14 days) is characteristic of asthma.
◾If FEV1 and the FEV1/FVC ratio return to normal with drug therapy, clinically significantly COPD is not present.
◾Significant diurnal or day-to-day variability of serial peak flow measurements suggest asthma.
◾If doubt still remains, refer the person for a specialist’s opinion.
What tests should be arranged for people with COPD?
- chest radiography to exclude other serious lung pathology (such as lung cancer)
- full blood count to identify anaemia or polycythaemia.
What tests should you arrange for people with suspected heart failure?
- Perform an ECG for all people with suspected heart failure.
- For people without a history of MI, check B-type natriuretic peptide (BNP) or N-terminal pro-B-type natriuretic peptide (NTproBNP) and refer to specialist assessment and echocardiography appropriately if raised above agreed levels for referral.
- For people with a history of MI, refer directly for urgent specialist assessment (to be seen within 2 weeks)
What tests should you arrange for people with suspected bronchiectasis?
- Arrange chest radiography to exclude other causes for the symptoms
- Refer to a respiratory specialist for confirmation of the diagnosis (by high resolution computed tomography scanning).
What tests should you arrange for people with suspected Pleural effusion?
Arrange chest radiography to confirm the diagnosis
What tests should you arrange for people with suspected lung/pleural cancer?
Arrange an urgent chest X-ray (to be performed within 2 weeks) in people aged 40 years and over with breathlessness if:
◾They have ever smoked; or
◾They have been exposed to asbestos; or
◾They have any of the following unexplained symptoms; cough, fatigue, chest pain, weight loss, appetite loss
An urgent chest X-ray (to be performed within 2 weeks) should also be considered in people aged 40 years and over if they have any of the following:
◾Persistent or recurrent chest infection.
◾Finger clubbing.
◾Supraclavicular lymphadenopathy or persistent cervical lymphadenopathy.
◾Chest signs consistent with lung cancer or pleural disease.
◾Thrombocytosis.
What tests should you arrange for people with suspected abdominal splinting secondary to ascites?
◦Arrange an abdominal ultrasound scan to confirm the presence of ascites and to exclude or confirm liver cirrhosis and peritoneal cancer. Arrange other investigations guided by clinical findings (for example liver function tests or erythrocyte sedimentation rate; for signs of cancer).
◦Awaiting results of investigations should not delay urgent referral if cancer is suspected.
