Dyspnea Flashcards
Dyspnea is subjective or objective?
Subjective
What is dyspnea?
A subjective sensation of shortness of breath or breathing discomfort
What is chronic dyspnea?
Sx greater than 1 month
T/F underlying cause of dyspnea is not directly related to duration or severity
True
How do pts describe dyspnea?
“I cant catch my breath”
“chest tightness”
What % accounts for FP visits for dyspnea?
4%
What age gets dyspnea?
Pediatrics and 55-69 years of age
T/F A large percentage of patients will have an already diagnosed cardiopulmonary disorder which accounts for the dyspnea
True
Dyspnea is approximately 2/3rds of cases are caused by _____?
Pulmonary or cardiac disorder
85% of dyspnea is caused by (detailed list)?
Asthma, CHF, COPD, PNA, cardiac ischemia, interstitial lung disease
What are the 1/3 (not caused by heart/lungs)?
Metabolic, deconditioning, anemia, or psychogenic
About what # of pt will have another complaint?
2/3
Mostly cough (17%)
T/F The diagnosis can be made in half of all patients with history alone (if a good history is taken!)
True
T/F Dyspnea is not multifactorial
False, it is multifactorial
Which (lung/cardiac) has slower onset?
Lung
Dyspnea at rest is most likely lung or cardiac?
Lungs
Cough that is more productive is more lungs or cardiac?
lungs
Which (lungs/cardiac) has more rapid onset?
Cardiac
Dyspnea with exertion is more likely (lung/cardiac)?
Cardiac
T/F Cough is common with cardiac dz
False, cough is rare
What are sx to send immediately to the ER?
Acute respiratory distress
- Labored (Wheezing, accessory muscle use, unable to speak in full sentence (two/word dsypnea).
- cyanotic, word dyspnea
(Chest pain)
(Hypoxic)
T/F 87% can be normal for pt with lung dz
True
In addition to O2 %, what should you keep in mind?
vital signs
COPD’s what is highest PE exam correlation
Wheezing
what is most specific question for CHF?
DOE is the earliest symptom, but PND is more specific
T/F S3 gallop is never normal
True
What is S3 gallop associated with?
CHF
New murmur is associated with?
CHF
Which lung disease has slow progression of exertional dyspnea?
ILD
What is present in 80% of pt with ILD?
Persistent inspiratory crackles
25-50% will have what with ILD?
Clubbing
What does normal O2 implies?
a mild disorder such as exercise-induced bronchospasm
What does abnormal O2 with exertion implies?
mild to moderate cardiopulmonary disease
What does abnormal O2 at rest implies?
moderate to severe cardiopulmonary disease
Whats important to get with in lung dz pt?
Walking O2
Whats the diagnostic approach for dyspnea?
If you get good H&P, you will prob have a diagnosis
T/F Patients who present with dyspnea as a primary complaint are more likely to get an EKG than lung function testing
True but it needs to change
What is your first choice of test for dyspnea?
PFT
What is obstructive for FEV1 and FEV1/FVC?
FEV1 = <80%
FEV1/FVC? = <70%
What are the obstructive lung dz?
COPD
Asthma
Bronchiectasis
What is FEV1 and FEV1/FVC for restrictive?
FEV1 = <80%
FEV1/FVC? = >70%
What are example of restrictive lung dz?
Interstitial lung disease
Pulmonary fibrosis
Obesity
Autoimmune diseases
Pleural effusion and heart failure
How can EKG help in eval of dyspnea?
Cardiac ischemia or infarction
Ventricular hypertrophy
Pericardial disease
Eval of dyspnea with CXR
Chest wall abnormalities, hyperinflation, CM or pleural effusions, Mass/Mets, PNA
- good for dyspnea
When would you order CT chest?
I have no idea what’s causing this patients dyspnea…
Interstitial lung disease, bronchiectasis, PE
You will see PE with this
List the dx test
- EKG
- CXR
- CTA PE
- High res CT chest
- CBC
- BMP
Why would you order CBC with dyspena?
Anemia
Infection
COPD
Why would you order BMP with dyspena?
Acid-Base disturbance (bicard level)
Metabolic acidosis
T/F BNP is good for CHF?
Yes, the higher it is, worse their CHF is
T/F Echo is high yield for pt who we think have CHF
True
Can paroxysmal afib cause dyspnea?
Yes, best with holter monitor
If it doesn’t correlate with anything, sometimes at night, sometimes day etc what should you get?
Holter Monitor
How will Lung bx help with eval of dyspnea- PANCE
Interstitial lung disease
Malignancy
When should we refer dyspnea pt?
- Underlying cause of dyspnea is unclear
- Symptoms disproportionate to the apparent severity of the disease
- For lung biopsy
- Patient not adequately responding to treatment
