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
Non Cardiac/Pulmonary Etiology! What should we think? (This is kind of repetitive)
- Metabolic Condition (Acidosis)
- Pain
- Anemia
- Neuromuscular Disorders
- Chemical Exposure
- Functional (Anxiety, Panic Disorders, Hyperventilation)
T/F: There can be one specific cause of dyspnea and a specific treatment.
False! There is no one specific cause of dyspnea and no single specific treatment.
Chief Complaint of Chest Tightness would lead you to think?
Myocardial Disease
Chief Complaint of Chest Tightness assc. with air hunger would lead you to think?
Asthma
Chief Complaint of being “unable to take a deep breath, just can’t get their air in” would lead you to think?
COPD
Chief Complaint of Suffocation or Smothering would lead you to think?
CHF
Chief Complaint of Heavy Breathing would lead you to think?
Deconditioning
What is the single most useful diagnostic modality?
History – 75% of dyspnea presentations can be diagnosed by the history.
*Differentiating between cardiac and pulm path as a cause of the dyspnea is a challenge. Pulm and Cardiac problems can coexist
History Questions to Ask for Dyspnea
- Was the onset sudden or gradual?
- Is the dyspnea constant or intermittent?
- Does it occur during activity or while at rest?
- If the patient has had dyspnea before, is it getting worse?
- What effect does it have on the patient’s ADLs?
- Is there an aggravating factor?
- Is there an alleviating factor?
- Are there other symptoms (cough, sputum, chest pain, orthopnea, PND, hemoptysis, fatigue, urticaria)
- Is there a history of trauma?
- Is there a history of infection?
- Is there a history of DVT? Inactivity? OCPs?
- Does the patient smoke?
- Does the patient have occupational exposures?
Other signs to look for with Dyspnea complaints
- Accessory muscle use (may even have hypertrophy if chronic)
- Fever
- Pursed lip breathing
- Cyanosis
- Clubbing
- Barrel Chest
- Adventitious breath sounds (crackles/wheezes/rhonchi/rubs)
- Peripheral Edema
- Diaphoresis
- JVD
- Murmurs
- Abnormalities in BP
- Arrhythmias
- Murmurs
- Hepatosplenomegaly
- Ascites
- Obesity
Lab Studies to think about NEVER order all!
- Pulse Ox
- CXR
- PFTs
- DLCO
- EKG
- Echo
- CBC
- CT
- ESR
- Cardiac Enzymes
- Tox Screen
- BNP
- ABG
- Stains, Culture, Cytology of Sputum
- V/Q Scan
- Angiography
