Dyspnea Flashcards
1. Identify the physical and psychological etiologies of dyspnea. 2. Discuss the pathophysiology of dyspnea. 3. Create a treatment plan for a patient presenting with dyspnea. 4. List a differential diagnosis for an adult or pediatric patient presenting with dyspnea. 5. Obtain a history and physical examination specific to shortness of breath and dyspnea. 6. Compare and contrast laboratory and radiological tests used in the evaluation of shortness of breath.
Is Dyspnea a subjective or objective finding?
Subjective
Is Tachypnea a subjective or objective finding?
Objective – Rapid RR!
T/F: The mechanisms producing dyspnea and tachypnea are the same.
True! It is the inadequate oxygen amount for the body needs or the inability to excrete CO2.
Pathophysiology of Dyspnea
- Decreased intake of oxygen.
- Impaired absorption of oxygen.
- Inadequate perfusion of the lungs with blood.
- Inability of the body to transport enough oxygen to the tissues.
- Increased demand of the tissues for oxygen.
- Inability of the body to excrete CO2 and other waste products of metabolism.
List of conditions that may block the respiratory passages that could lead to decreased intake of oxygen.
- Laryngitis
- Foreign Bodies
- Asthma
- Acute Bronchitis
List of conditions that interfere with the muscles of inspiration that could lead to decreased intake of oxygen.
- Kyphoscholiosis
- Amyotrophic lateral sclerosis
- Peritonitis
List of conditions that interfere with the respiratory center in the brain that could lead to decreased intake of oxygen.
- Encephalitis
2. Brain Tumors
What is another factor that can decrease the intake of oxygen?
High Altitude
Impaired absorption of oxygen (aka lowered oxygen diffusion) would be reflected where on a PFT?
DLCO
List of condition that involve lowered oxygen diffusion across the alveolar-capillary membrane.
- Lobar pneumonia (most common)
- Sarcoidosis
- Silicosis (inhalation of silica)
- Idiopathic Pulmonary Fibrosis
- Pulmonary Edema
- ARDS
Conditions in which unoxygenated blood bypasses the alveoli (has inadequate perfusion of the lungs with blood).
- Pulmonary Embolism
- Congential Heart Disease
Diseases with ventilation-perfusion defects (has inadequate perfusion of the lungs with blood).
- Emphysema
- Pneumoconioses (inhalation of dust)
These conditions can cause tissues to not get oxygen if there is not enough blood to transport it.
- Anemia
- Hemorrhagic Shock
These conditions can cause tissues to not get oxygen if there is not enough blood pressure to perfuse them.
- Vasomotor Shock
- Cardiogenic Shock
This condition can cause tissues to not get oxygen if the heart pump fails.
Congestive Heart Failure
These conditions can cause tissues to not get oxygen if the blood is unable to carry it.
- Methemoglobinemia
- Carbon Monoxide Poisoning
This is a state that occurs when the iron atom in deoxyhemoglobin loses an electron, resulting in a ferric (Fe3+) ion instead of the usual ferrous (Fe2+) state.
Methemoglobinemia
What disease states can cause an increased metabolism and therefore an increased demand of the tissue for oxygen?
- Nervous Stress/Panic Disorders
- Fever
- Leukemia
- Malignancies
- Hyperthyroidism
What is a common state that can cause an increased metabolism and therefore an increased demand of the tissue for oxygen?
Exercise
What diseases can lead to the inability of the body to excrete CO2 and other waste products?
- Emphysema
- Lactic Acidosis
- Diabetic Acidosis
- Uremia
What are the 4 general categories to think about when a patient presents with “dyspnea?”
- Cardiac
- Pulmonary
- Mixed Cardiac or Pulmonary
- Non-cardiac or non-pulmonary
Pulmonary Etiology! What should we think? (This is kind of repetitive)
- Asthma
- COPD
- Pneumonia
- Pneumothorax
- Pulmonary Embolism
- Pleural Effusion
- Restrictive Lung Disorders (ILD)
- Hereditary Lung Disorders
- Pulmonary Hypertension
- Cancer
Cardiac Etiology! What should we think? (This is kind of repetitive)
- CAD
- MI (recent or past history)
- CHF
- Cardiomyopathy
- Valvular Dysfunction
- Left ventricular hypertrophy
- Pericarditis
- Arrhythmias
Mixed Cardiac/Pulmonary Etiology! What should we think? (This is kind of repetitive)
- COPD with Pulmonary HTN and/or Cor Pulmonale
- Deconditioning