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7. Vascular > Lecture: breathlessness > Flashcards

Lecture: breathlessness Flashcards

1
Q

How would you classify breathlessness?

A
  1. Acute (seconds or minutes)
  2. Subacute (hours or days)
  3. Chronic (weeks or months)

Or:

  1. Respiratory
  2. Cardiac
  3. Miscellaneous
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2
Q

What are respiratory causes of breathlessness?

A
  1. Acute asthma
  2. Pneumonia
  3. COPD
  4. PE
  5. Pleural effusion
  6. Lobar collapse
  7. Upper airway obstruction
  8. ARDS
  9. Exacerbation off bronchiectasis
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3
Q

What are cardiac causes of breathlessness?

A
  1. Heart failure (pulmonary oedema)
  2. Silent MI (especially in diabetes)
  3. Pericardial effusion (due to malignancy)
  4. Tachyarrhythmia
  5. Cardiac tamponade
  6. Acute valvular dysfunction
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4
Q

What are causes of acute valvular dysfunction?

A
  1. infective endocarditis
  2. Acute MI (papillary muscle dysfunction)
  3. Aortic dissection (acute aortic regurg)
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5
Q

What are miscellaneous causes of breathlessness?

A
  1. Anaemia
  2. Metabolic acidosis (DKA, acute renal failure)
  3. Acute blood loss
  4. Thyrotoxicosis
  5. Neuromuscular disease
  6. Anxiety and hyperventilation
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6
Q

What can cause silent MI?

A

Diabetes

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7
Q

What are the most common causes of breathlessness presenting to A&E?

A
  1. COPD
  2. Pulmonary oedema
  3. Pneumonia
  4. MI
  5. Atrial fibrillation (can be caused by alcoholism) and flutter
  6. Pulmonary embolism
  7. Malignant tumour
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8
Q

How would you structure a breathlessness history?

A
  1. Duration, pattern, severity of SOB (what can’t you do now, which you could do in the past?) (NYHA heart failure classification!)
  2. Cough, sputum, haemoptysis, wheeze
  3. Systemic upset - fever, night sweats, malaise
  4. HF symptoms - orthopnoea, PND, peripheral oedema
  5. Other cardiac symptoms - chest pain, palpitations
  6. PE risk factors
  7. PMHx (CCF, COPD, asthma, IHD)
  8. Smoking history
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9
Q

How would you structure a breathlessness examination??

A
  • Do they look well or unwell?
  • ABCDE approach
    1. Heart rate
    2. Respiratory rate
    3. Oxygen saturation
    4. Blood pressure
    5. Fever and GCS
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10
Q

What are signs of respiratory distress?

A
  • Stridor
  • Nasal flaring
  • Cyanosis
  • Accessory muscle use
  • Tracheal tug (paeds)
  • Intercostal recession
  • Interrupted sentences
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11
Q

What can a systolic BP differential be indicative of?

A

aortic dissection or wide pulse pressure (acute AR)

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12
Q

What can a pulsus paradoxus be indicative of?

A

cardiac tamponade, asthma exacerbation

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13
Q

What can an elevated JVP be indicative of?

A

acute LVF, PE, cor pulmonale, cardiac tamponade

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14
Q

What can reduced chest expansion be indicative of?

A

pneumothorax, collapse, effusion, cardiac tamponade

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15
Q

What are the core investigations for breathlessness?

A
  1. Routine bloods
  2. Biomarkers
  3. ECG
  4. ABG
  5. CXR
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16
Q

What are three common and important biomarkers and what do they indicate?

A
  1. D-dimer (PE; high sensitivity and high NPV)
  2. NT-proBNP (heart failure; high sensitivity and high NPV)
  3. Serial troponin (MI or myocardial injury, NOT per se ACS)
17
Q

What is a globular heart on a CXR indicative of?

A

Pericardial effusion

18
Q

What is widening of the mediastinum on a CXR indicative of?

A

Aortic dissection

19
Q

When would you consider an emergency echo?

A

99% not necessary!

  1. Patient in cardiogenic shock (look at LV function)
  2. Cardiac tamponade (no pulmonary effusion; clear chest but cardiomegaly)
  3. Acute valvular dysfunction
  4. Massive PE (RV strain)
  5. Type A aortic dissection (but should really do CT scan)
20
Q

What oxygen do you give when a patient is breathless?

A
  • 15L per minute via non-rebreather mask if O2 <94% unless COPD
  • 4L per minute 28% Venturi mask if COPD
21
Q

What are signs of an MI?

A
  1. Dynamic T wave inversion
  2. ST elevation
  3. ST depression
22
Q

How would you rate control in AF?

A

1st line: ß-blocker or CCB

2nd line: digoxin

7. Vascular (15 decks)

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