Dyspnea

Question 1

American Thoracic Society definition of dyspnea

Answer 1

• Subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity
• The experience derives from interactions among multiple physiological, psychological, social, and environmental factors, and may induce secondary physiological and behavioral responses

Question 2

Pathogenesis of dyspnea

• Description
  
  • Pathophysiology

Answer 2

• Chest tightness or constriction
  
  • Bronchoconstriction
  • Interstitial edema (asthma, MI)
• Increased work or effort of breathing
  
  • Airway obstruction (COPD, uncontrolled asthma)
  • Neuromuscular disease (myopathy, kyphoscoliosis)
• Air hunger, need to breathe, urge to breathe
  
  • Increased drive to breathe (CHF, pulmonary embolism, moderate-severe airflow obstruction)
• Cannot get a deep breath, unsatisfying breath
  
  • Hyperinflation (asthma, COPD)
  • Restricted tidal volume (pulmonary fibrosis, chest wall restriction)
• Heavy breathing, rapid breathing, breathing more
  
  • Deconditioning

Question 3

Causes of orthopnea

Answer 3

• CHF
• Mechanical impairment of the diaphragm associated with obesity
• Asthma triggered by esophageal reflux

Question 4

Paroxysmal nocturnal dyspnea is suggestive of ____ or ____

Answer 4

CHF or asthma

Question 5

1. Acute, intermittent episodes of dyspnea are more likely to reflect episodes of ____, ____ or ____
2. Chronic persistent of dyspnea are typical of ____, ____ or ____

Answer 5

1. Myocardial ischemia, bronchospasm, pulmonary embolism
2. COPD, interstitial lung disease, and chronic thromboembolic disease

Question 6

Causes of platypnea

Answer 6

• Left atrial myxoma
• Hepatopulmonary syndrome

Question 7

Variations of dyspnea

Answer 7

• Orthopnea
• Paroxysmal nocturnal dyspnea
• Acute, intermittent episodes of dyspnea
• Chronic persistent of dyspnea
• Platypnea