Jaynstein - Dyspnea Flashcards
chronic dyspnea is defined as SOB >
1 month
t/f: the severity of dyspnea correlates w. severity of pathology
f!
how might a pt describe sensation of dyspnea (2)
i can’t catch my breath
chest tightness
*it’s a subjective feeling of SOB or breathing discomfort
dyspnea accounts for __% of all FP visits
4
i guess we need to know these stats
what 2 pt pops does dyspnea affect
peds
55-65 yo
where do most dyspnea pt’s present
ED
dyspnea is usually an __ attack of a __ process
acute
chronic
majority have preexisting cardiopulmonary d.o
what fraction of dyspnea is related to cardiopulmonary d.o
2/3 (67%)
2/3 of dyspnea pt’s fall into what ddx
asthma
chf
copd
PNA
ischemia
ILD
1/3 of dyspnea pt’s fall into what ddx
metabolic
deconditioning
anemia
psychogenic
what pt pop does dyspnea related to deconditioning make you think of
older pt’s
cardiac causes of chronic dyspnea (> 1 mo) (5)
CHF
CAD
arrhythmias
pericardial dz
valvular dz
pulmonary causes of chronic dyspnea (6)
COPD
asthma
ILD
pleural effusion
malignancy (primary vs metastatic)
bronchiectasis
non cardiac causes of chronic dyspnea (11)
thromboembolic dz
psychogenic causes
deconditioning
pulmonary HTN
obesity
severe anemia
GERD
metabolic
cirrhosis
thyroid dz
neuromuscular (myasthenia gravis)
3 psychogenic causes of dyspnea
GAD
PTSD
panic disorder
__ of pt’s will have another complaint w. dyspnea
2/3
mc complaints associated w. dyspnea (6)
cough
cp
fatigue
ran out of meds
wheezing
peripheral edema
__ of patients w. dyspnea have concurrent pathology
1/3
ex COPD w.URI
cause of dyspnea can be determined by history alone in __% of pt’s
50
4 factors suggesting dyspnea related to lung dz (4)
h.o smoking
slower onset
resting dyspnea
productive cough
3 factors suggesting dyspnea related to cardiac dz
h.o HTN/obesity/valve d.o
rapid onset
exertional dyspnea
__ is rare if dyspnea is related to cardiac cause
cough
what do you think when you see: increased WOB, feeling of suffocation, and air hunger
COPD
what do you think when you see: rapid breathing, feeling of suffocation, and air hunger
CHF
what do you think when you see increased WOB alone
ILD
what do you think when you see: incomplete exhalation, shallow breathing, increased WOB, chest tightness, and heavy breathing
asthma
what do you think when you see: shallow breathing and increased WOB
neuromuscular and chest wall dz
what do you think when you see air hunger alone
pregnancy
what do you think when you see rapid breathing alone
pulmonary vascular dz
how does SOB affect related tachypnea/bradypnea
initially: tachypnea
later: bradypnea
5 signs of acute respiratory distress (punt them)
labored breathing
cyanotic
word dyspnea
chest pain
hypoxia
important history consideration with hypoxia
baseline SpO2
t/f: SOB alone indicates “sick” pt
f!
what do you think when you see a pt w. SpO2 93% who is tachycardic
PE
what symptom has the highest LR related to COPD
wheezing (15)
besides wheezing, 4 other symptoms with high LR related to COPD
smoking hx > 40 years
ronchi
hyperresonance to percussion
FE time > 9
poor man’s bedside exam for COPD
forced expiratory time
gs test for COPD
PFTs
earliest symptom of CHF:
symptom most specific for CHF:
earliest: DOE
most specific: paroxysmal nocturnal dyspnea
3 PE findings with high LR suggesting CHF
S3 gallop
displaced PMI
JVD
5 findings that increase likelihood of CHF 80%
DOE
paroxysmal nocturnal dyspnea
S3 gallop
displaced PMI
JVD
most important aspect of asthma diagnosis
history!!
more important than PE
what do you think when you see slow progression of exertional dyspnea
ILD
pt usually presents when it has progressed to dyspnea at rest
what lung sound is heard in 80% of pt’s w. ILD
inspiratory crackles that are present after coughing
symptom that suggests advanced ILD
clubbing
what does dyspnea w. normal SpO2 suggest
mild disorder -> exercise-induced bronchospasm
what does abnormal SpO2 with mild exertion suggest
mild-mod cardiopulmonary dz
what does abnormal SpO2 at rest suggest
moderate to severe cardiopulmonary dz
what simple test can you do to evaluate severity of dyspnea
walking O2 ->
if SpO2 remains stable w. continuous walking, underlying pathology is unlikely
first line test for cc of dyspnea
hint: it’s not EKG ;)
PFTs
what do normal PFTs indicate in a pt w. cc of dyspnea
pt is very unlikely to have significant cardiopulmonary dz w. the exception of asthma
what is the obstructive PFT pattern
FEV < 80%
FEV1/FVC < 70%
what is the restrictive PFT pattern
FEV 1 < 80%
FEV1/FVC > 70%
what are the obstructive respiratory diseases (3)
COPD
asthma
bronchiectasis
what are the restrictive lung diseases (6)
ILD
pulmonary fibrosis
obesity
AI
pleural effusion
HF
when are EKG’s helpful in pt w. dyspnea (4)
cardiac ischemia
MI
ventricular hypertrophy
pericardial dz
when is CXR helpful in pt w. dyspnea (6)
chest wall abnormalities
hyperinflation
CM
pleural effusion
mass/mets
PNA
when is CTA useful for pt w. dyspnea
PE
when would you order a chest CT for pt w. dyspnea (2)
you have no idea what’s going on
ILD
bronchiectasis
PE
CBC might be useful for diagnosis what conditions related to dyspnea (3)
anemia
infxn
COPD
what is the use of a BMP helpful in dyspnea work up
to evaluate acid-base disturbance
what does elevated bicarb + SOB indicate
metabolic alkalosis ->
COPD
ILD
neuromuscular d.o
what does low bicarb + SOB indicate
metabolic acidosis ->
DKA
t/f: a single troponin is useful to r.o MI
f! you need 2
unless it’s been like 12 hr w.o CP
t/f: a single elevated troponin can rule in MI
t!
BNP > __ is __% sensitive and __% specific for CHF
100
82% sensitive
99% specific
t/f: the higher the BNP, the worse the CHF
t!
t/f: the higher the troponin, the worse the MI
f!
BNP is super helpful in what condition
dx and monitoring of CHF
what is the usefulness of echo in eval of dyspnea
gives us info about structural issues in pt’s w. CHF
what arrhythmia might be an easily missed cause of dyspnea
proxysmal afib -> order holter monitor
lung bx is the gs for dx of (2)
ILD
malignancy
what do you think when you see a pt w. diagnosed cardiopulmonary disorder who has chronic dyspnea despite max therapy
the presence of a cofactor ->
obesity
deconditioning
emotional response to illness
4 indications to refer a dyspnea pt
underlying cause is unclear
sx disproportionate to apparent dz severity
lung bx
not adequately responding to tx
