Johns- Shortness of Breath Flashcards
A patient comes in who has abnormally uncomfortable awareness of their breathing…
Dyspnea
can be with or without exertion
What should be on your differential for dyspnea on exertion (DOE)?
CHF Angina Obstructive airway disease anemia hypothyroid metabolic acidosis anxiety and hyperventilation
What should be on your differential for dyspnea NOT related to exertion?
Sudden episodes at rest:
PE
Pneumothorax
Anxiety
What is orthopnea
Dyspnea when supine
CHF, asthma, COPD
What is PND (paroxysmal nocturanal dyspnea)?
Waking at night short of breath
CHF, COPD
What is trepopnea?
Dyspnea when lying on side
CHF
What is the pathophysiology of dyspnea?
We don’t really know….
Stimulation of chemoreceptors, stretch receptors, intrathoracic receptors—> brainstem respiratory centers
What is CHF?
- Syndrome of dyspnea on exertion
- Edema of the lungs or extremities
- fluid retention resulting from cardiac dysfunction
What causes LV failure?
- CAD
- Valvular heart disease
- Hypertension
- Congenital defects
What causes RV failure?
Most commonly:
- LV failure
- Tricuspid regurgitation
Others: mitral stenosis, primary pulmonary hyptertension, multiple pulmonary emboli, pulmonary valve stenosis, RV infarction
What is high output failure?
A persistent high CO that eventually results in ventricular dysfunction
What causes high output failure?
anemia beriberi thyrotoxicosis preganancy AV fistulas
What is systolic dysfunction and what causes it?
Ventricular contractile dysfunction
- CAD
- Hypertension
- Dilated congestive cardiomyopathy
What is diastolic dysfunction? What causes it?
Prolonged ventricular relaxation time and resistance to filling (ventricular STIFFNESS)
Hypertension
Age
What is BNP?
Neurohormone secreted from the cardiac ventricles in response to volume expansion and pressure overload
Why is BNP useful?
It differentiates CHF from other causes of dyspnea
What are symptoms of heart failure?
dyspnea L orthopnea L PND L fatigue L and R Weakness L and R Leg Edema R Abdominal Fullness R
What physical findings are associated with heart failure?
Lung crackles (rales) L Dullness to percussion of lung bases (effusion) L Elevated JVD- positive hepatojugular reflux L or R S3 L Mitral insufficiency ankle edema R hepatomegaly R ascites R
What is the NYHA functional classification for CHF?
I- no limit
II- some limit
III- marked limit
IV- sxs at rest
How do you diagnose CHF?
- Physical Exam
- Chest x ray (cardiomegaly, pulmonary venous congestion, pleural effusions)
- ECG (r/o) MI
- Echocardiography (decreased LV function, diastolic dysfunction)
- Stress testing or coronary angiography (if CAD suspected)
What can be used to decrease preload in CHF?
- Diuretics (furosemide, ethacrynic acid)
- Vasodilators (isosorbide dinitrate, nitroglycerine)
**by themselves don’t increase survival
What can be used to increase myocardial contractility when treating CHF?
- Digoxin- only commonly used oral med (reduces MORBIDITY in pts also on diuretics and ACE inhibitors)
- Dobutamine- given IV only (used in acute CHF in hostpital)
What is used to decrease afterload in treating CHF?
- Arterial vasodilators (apresoline)
- ACE inhibitors- dilate arteries and veins (captopril, enalapril)
- Angioreceptors II receptor blockers (Losartan)
What drugs will reduce mortality in CHF treatment?
ACE inhibitors
ARBs
