Dyspnea Flashcards

1
Q

Define Dyspnea

A

Breathing discomfort of varying intensity

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2
Q

Define Chronic dyspnea

A
  • Dyspnea ongoing for >1 month

- Acute is more life threatening

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3
Q

Shortness of Breath

A
  • SOB
  • Description of dyspnea
  • Different than dyspnea on exertion (DOE)
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4
Q

Define orthopnea

A
  • Dyspnea while lying supine

- Occurs in CHF due to pulmonary edema

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5
Q

Define paroxysmal nocturnal dyspnea (PND)

A
  • Waking up suddenly at night due to SOB
  • Specific finding in CHF
  • Also occurs in obstructive sleep apnea, GERD, Asthma, & PTSD
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6
Q

Define Platypnea

A

-Dyspnea worsening in the upright position

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7
Q

Define orthodeoxia

A
  • Drop in arterial pO2 in upright position

- Occurs in arteriovenous malformations (liver disease)

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8
Q

BNP

A
  • Brain natriuretic peptide
  • Neurohormone from myocytes of ventricles
  • Produced in response to fluid overload
  • Suggestive of CHF
  • If <100pg/mL makes CHF VERY unlikely
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9
Q

Define Vocal cord dysfunction

A
  • Vocal cords contract on inspiration (opposite of normal)
  • Occurs with stress or irritation
  • Causes SOB and wheezing
  • Often confused with asthma
  • Diagnosed with flow volume loop and laryngeal scope
  • Treat with speech therapy
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10
Q

Causes of Tachypnea

A
  • CHF

- Pulmonary vascular disease

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11
Q

Symptoms of Asthma

A
  • Incomplete exhalation
  • Heavy breathing
  • Tight chest
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12
Q

Causes of shallow breathing

A
  • asthma
  • neuromuscular disease
  • chest wall disease
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13
Q

What diseases cause increased work or effort in breathing

A
  • COPD
  • Interstitial lung disease
  • Asthma
  • neuromuscular disease
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14
Q

Causes of feeling like suffocating

A
  • COPD

- CHF

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15
Q

Causes of Air Hunger

A
  • COPD
  • CHF
  • Pregnancy
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16
Q

Timing of dyspnea

A
  • Intermittent:
    • Asthma
    • Recurrent PE
    • Cardiac Ischemia
  • Chronic:
    • COPD
    • Fibrosis
17
Q

Presentation of Congestive Heart Failure

A
  • DOE, PND, orthopnea, edema
  • HTN, JVD, murmur, gallop, HJR, crackles, wheezing
  • CXR: cardiomegaly, interstitial edema, kerley B lines
  • BNF <100 rules OUT CHF
  • Troponins: increased indicates infarction/ischemia
  • ECG:
    • infarction: ST elevation, Q waves, LBBB
    • Ischemia: ST depression, T wave changes
    • Arrhythmia
    • Low QRS voltage: pericardial effusion
    • HIgh QRS voltage: hypertrophied ventricle
18
Q

Presentation of Acute Coronary Syndrome

A
  • Risks: male >45; female>55; diabetes, obesity, family history, smoking, high LDL, low HDL
  • History: radiating chest pain, diaphoresis, SOB
  • Physical: tachycardia, signs of HF, painful palpitations
  • Same tests as CHF
19
Q

Clinical Presentation of Pneumonia

A
  • Risks: elderly and immunocompromised
  • History: cough, purulent sputum, pleuritic chest pain, chills, myalgia
  • Physical: Fever, rhonchi, increased fremitus
  • CXR: consolidation or air space in area of infection
  • Tests:
    • Blood: Increased WBC w/ band forms (LT shift)
    • Blood and sputum cultures
20
Q

Clinical Presentation of Pulmonary Embolism

A

-Risks: Immobilization, surgery, DVT, prior PE, cancer, travel, pregnancy, oral contraceptives
-History: sudden onset SOB, syncope, pleuritic chest pain, hemoptysis
Physical: fever, tachypnea, tachycardia, hypoxia, hypotension, RT heart failure
-Signs of DVT: Homan’s sign (leg pain w. foot dorsiflexion)
-CXR: May be normal
-Atelectasis, effusion, infiltrate
-Westermark’s sign: loss of vasculature markings due to low blood flow beyond clot
-Hampton’s hum: wedge/triangle opacity from infarction
-Additional test: CT angiogram, D dimer, ECG

21
Q

Clinical presentation of COPD

A
  • History: purulent sputum, smoking, dyspnea
  • Symptoms improve w. bronchodilator, worse w/ B-blockers
  • Physical: barrel chested, finger clubbing
  • CXR: air trapping including flattened diaphragms
  • Pulmonary function test: FEV1/FVC < 70%
22
Q

Clinical presentation of asthma

A
  • Also obstructive lung disease
  • History: dyspnea, wheezing, chest tightness, coughing
  • Physical: normal b/t episodes; wheezing, prolonged expiratory time, decreased breath sounds
    • Use accessory muscles
    • Pulsus paradoxis
  • Pulmonary Function test: FEV1/FVC < 70%
23
Q

Clinical Presentation of Pneumothorax

A
  • History: sudden onset plueritic chest pain, not relieved w/ O2 therapy
  • Physical: absent breath sounds
    • tracheal deviation away from effected side
    • Hyperresonance
    • Deep sulcus sign: supine sharper than normal costophrenic angles
  • Additional test: CT