Presentation Flashcards
How can SOB present as? (time-wise)
Acute; Subacute; Chronic
What are the conditions associated with Acute SOB?
LUNGS:
1) Pulmonary EMbolism
2) Pneumothorax
3) **Respiratory infections (pneumonia)
**
Heart:
1) Acute MI
2) Acute HF
Other:
1) Anaphylaxis that closes Upper airway
Potentially life threatining conditions that require immediate attention
What conditions are related to Chronic Dyspnea?
Heart:
LHF
Lung:
Interstitial Lung Disease
COPD (asthma + Chronic Bronchitis)
Blood: `
Anemia
Other:
Deconditioning
long-standing disease, allowing for compensatory adaptations in the body
Cardiac Causes of SOB
1) LHF
+ Paroxysmal Nocturnal Dysnea
+ Orthopnea when lying down
+ Pulmonary congestion (crackles)
+ S3 Gallop
2) MI/ Infarction
+ Chest Pain (unless silent MI) that radiates
+ MC: Elderly and DM pts
3) Arrhythmias (afib and Tachyarrhythmias)
+Rapid or irregular heart rhythms (atrial fibrillation) reduce cardiac output, leading to shortness of breath and Palpitations
+Tachyarrhythmias would have Rapid HR (decreases Ventricular filling, reducing SV/CO)ysnea
4) Valvular Diseases
AS: Excertional dysnea, angina, and syncope because of Reduced Cardiac Output
MS: Hemptysis, Fatigue from Impared LA outflow
5) Pericardial Effusion and Temponade:
+Decreased Heart filling causing the SOB
+Muffled Heart sounds
+Pulsus Paradoxus
RHF can be caused by LHF and chronic lung disease (cor pulmonale). Signs include perepheral edema, ascites, elevated JVP
Pulmonary Causes of SOB
1) Chronic Bronchitis
+Smokers hx
+Productive cough (3yrs, <2months space between)
+Progressive breathlessness
+Emphysema (trouble breathing due to alveolar wall damage)
2) Asthma:
+Reversible smooth muscle contraction
+Triggered by Cold, Allergens, and exercise.
3) Pneumonia
+Cough with Sputum Production
+Fever
+/- Pain on inspiration
4) PneumoThorax
+ Painful inspiration
+Tall-Thin male (spontaneous)/ Trauma (tramatic Pneumothorax)
+Possible underlying lung disease
5) Pulmonary Embolism:
+Hemoptysis
+Painful inspiration
+Tachychardia
6) Intersitial Lung Disease (pulomary fibrosis, sarcodosis, pneumoconiosis)
+RLD pattern on PFT
+Dry cough
+Trouble Inhaling
Other causes of SOB?
1) Amenia
+Reduced Oxygen Carrying Capacity
2) Metabolic Acidosis
+Diabetic ketoacidosis compensatory hyperventilation (Kussmaul respiration- Rapid and deep)
3) Psychogenic
+Anxiety
+Panic attack/disorder
Notable factors that should be considered in SOB history
OPQRST (Onset, Provocation, Quality, Radiation, Severity, and Timing).
Onset (day- yrs)
Provocation
Quality of breathing sounds
Radiation
Severity (mild/mod/severe)
Timing (quick, gradual)
——————————–
NOTES:
* History: Document onset, duration,
pattern (episodic or persistent),
position (e.g., orthopnea), and associated symptoms (e.g., chest pain, palpitations, fever).
P/E for SOB
General:
Check for pallor (anemia),
Anxiety
Leg swelling (suggesting DVT).
Cardio:
+Elevated JVP
+Perepheral Edema
+S3 Gallop
Lungs:
+Increased Work on Breathing
+Wheeze and Crackles on Breathing
+Percuss for Pneumothorax or Consolidation
Basic Tests for SOB?
ABCDEF
Arterial Blood Gas
BNP
CBC
D-Dimer
EKG
PFT
o Arterial Blood Gas (ABG):
Provides insight into oxygenation, ventilation, and acid-base status.
o B-type Natriuretic Peptide (BNP) or NT-proBNP:
Elevated levels indicate heart failure.
o Complete Blood Count (CBC):
To rule out anemia or infection.
o D-dimer:
Helps rule out PE, especially in low-risk patients.
o Electrocardiogram (ECG):
Can reveal signs of MI, arrhythmias, or PE (e.g., S1Q3T3 pattern).
o Pulmonary Function Tests (PFTs):
For chronic dyspnea to assess obstructive or restrictive lung diseases.
Imaging for SB
1) CXR
2) CT Pulmonary ANgiography
3) Echo
o Chest X-ray: Essential in evaluating pulmonary or cardiac causes, such as pneumonia, pleural effusion, or heart failure.
o CT Pulmonary Angiography: Gold standard for diagnosing PE.
o Echocardiography: Useful for assessing heart failure, valvular disease, or pericardial effusion.
Additinal factors that should be looked at for SOB
pneumonic VINDICATE
(Vascular, Infectious, Neoplastic, Degenerative, Iatrogenic, Congenital, Autoimmune, Trauma, Endocrine) can be helpful to ensure a comprehensive differential has been considered.
- Vascular
- Iatrogenic
- Neoplasm
- Degeneration
- Infection
- Congenital
- Autoimmune
- Tumor
- Endocrine
Immediate Lung treatment for SOB
Add DANO’s spice for that SOB’s Lngsu
Diuretics
ANticoagulants
Nebulizer
Oxygenuretic
- Diuretic if HF related, decrease Blood volume
- Anticoagulant to prevent additional blood clots related to PE or MI
- Nebulizer to open up airways in cases of Asthma and COPD (bronchospasms)
- Oxygen supplemented to increase/maintain oxygen levels (hypoxia)
Condition-Specific Treatments:
HF
Hf is BAD
BB
ACE/ARB
Diuretics (including ALdosterone ANtagonist - K sparing diuretics)
Condition-Specific Treatments:
COPD (asthma/ CB)
BronchoDialators (albuterol), possible corticosteroids for exasturbations
o Bronchodilators (e.g., albuterol) and corticosteroids for exacerbations.
o In stable cases, long-acting bronchodilators and inhaled corticosteroids help control symptoms and reduce exacerbations.
Condition-Specific Treatments:
Pulmonary Embolism
ANtiCoagulants to prevent further clots
Thrombolytics to breakdown the embolism
Condition-Specific Treatments:
Pneumonia
ABX (Microbe based)
Condition-Specific Treatments:
Psyc related SOB (Anxiety and panic attacks/disorders)
CBT
SSRI
LHF symptoms
1) LHF
+ Paroxysmal Nocturnal Dysnea
+ Orthopnea when lying down
+ Pulmonary congestion (crackles)
+ S3 Gallop
MI/Infaction symptoms
MI/ Infarction
+ Chest Pain (unless silent MI) that radiates
+ MC: Elderly and DM pts
Arrythmeia symptoms
Arrhythmias (afib and Tachyarrhythmias)
+Rapid or irregular heart rhythms (atrial fibrillation) reduce cardiac output, leading to shortness of breath and Palpitations
+Tachyarrhythmias would have Rapid HR (decreases Ventricular filling, reducing SV/CO)ysnea
Aortic stenosis symptoms
Valvular Diseases
AS: Excertional dysnea, angina, and syncope because of Reduced Cardiac Output
Mitral Stenosis Symptoms
Valvular Heart Disease
MS: Hemptysis, Fatigue from Impared LA outflow
Pericardial Effusion and Temponade: symptoms
Pericardial Effusion and Temponade:
+Decreased Heart filling causing the SOB
+Muffled Heart sounds
+Pulsus Paradoxus
COPD symptoms
1) Chronic Bronchitis
+Smokers hx
+Productive cough (3yrs, <2months space between)
+Progressive breathlessness
+Emphysema (trouble breathing due to alveolar wall damage)
Asthma Symptoms
Asthma:
+Episodic Reversible smooth muscle contraction
+Triggered by Cold, Allergens, Asprin, and exercise.
Pneumonia Symptoms
Pneumonia
+Cough with Sputum Production
+Fever
+/- Pain on inspiration
Pneumothorax Symptoms
PneumoThorax (air enters Pleural space, collapsing the lungs)
+ SHarp Painful inspiration
+Tall-Thin male (spontaneous)/ Trauma (tramatic Pneumothorax)
+Possible underlying lung disease
Pulmonary Embolism Symptoms
Pulmonary Embolism:
+Hemoptysis
+Painful inspiration
+Tachychardia
Intersitial Lung Disease symptoms
Intersitial Lung Disease (pulomary fibrosis, sarcodosis, pneumoconiosis)
+RLD pattern on PFT
+Dry cough
+Trouble Inhaling
Metabollic Causes of SOB and symptoms
DKA:
+Kussmaul Breathing (deep and rapid breathing pattern)
Lactic Acidosis:
+Conditions like sepsis, shock, and certain medications (e.g., metformin)
Neuromuscular Diseases causing SOB and symptoms
o Myasthenia Gravis:
Weakened respiratory muscle weakness, leading to dyspnea, particularly in a myasthenic crisis.
o Guillain-Barré Syndrome:
Progressive muscle weakness may involve respiratory muscles.
Close monitoring for ventilatory support.
How do you distinguish between the Jugular vein and the Carotid artery?
Palpable?
Yes–> Carotid
No–> Jugular
Wave movement:
Single: Carotid
Double: Jugular
Changes with respiration?
Yes: Jugular
No: Carotid
Red sputum: If frothy vs. Hemoptysis?
Frothy = HR
Hemoptysis= PE
- A 50-year-old man presents with chronic shortness of breath, a productive cough, and fatigue. He has a known history of asbestos exposure from his previous job as a construction worker. Chest X-ray shows interstitial markings and calcified pleural plaques. What is the most likely diagnosis?
· A) Interstitial lung disease
· B) Pneumonia
· C) Lung cancer
· D) COPD
A) ILD, Pneumoconiosis
Explanation: Asbestos exposure can lead to asbestosis, an interstitial lung disease with typical radiographic findings like pleural plaques.
- A 65-year-old man with known heart failure presents to the emergency department with acute shortness of breath, orthopnea, and frothy pink sputum. What immediate treatment should be administered?
· A) Thrombolytics
· B) Bronchodilators
· C) Antibiotics
· D) Oxygen therapy
Answer: D) Oxygen therapy
Explanation: Acute dyspnea with frothy, pink sputum suggests pulmonary edema from heart failure, requiring immediate oxygen and diuretics.
- A patient with progressive dyspnea undergoes pulmonary function testing, revealing an FEV1/FVC ratio of 60% and decreased FEV1. What is the most likely diagnosis?
· A) Interstitial lung disease
· B) Pulmonary embolism
· C) COPD
· D) Heart failure
Answer: C) COPD
Explanation: COPD is associated with an obstructive pattern on PFTs, characterized by a reduced FEV1/FVC ratio and decreased FEV1.
- A 50-year-old woman with progressive shortness of breath and a dry cough undergoes a high-resolution CT scan, which reveals honeycombing in the lung bases. What is the most likely diagnosis?
· A) COPD
· B) Interstitial lung disease
· C) Asthma
· D) Heart failure
Answer: B) Interstitial lung disease
Explanation: Honeycombing on CT is a hallmark of interstitial lung disease, especially idiopathic pulmonary fibrosis, often presenting with a dry cough.
- A 60-year-old man presents with fatigue and dyspnea on exertion. Laboratory tests show a hemoglobin level of 8 g/dL. Which of the following conditions is most likely contributing to his symptoms?
* A) COPD
* B) Heart failure
* C) Asthma
* D) Anemia
Answer: D) Anemia
Explanation: Anemia reduces oxygen-carrying capacity, causing fatigue and dyspnea, particularly on exertion
- A 70-year-old woman with known heart failure presents with worsening shortness of breath, especially at night. Physical exam reveals an S3 gallop. What does the presence of an S3 gallop indicate?
* A) Right ventricular overload
* B) Diastolic dysfunction
* C) Mitral stenosis
* D) Fluid overload
Answer: D) Fluid overload
Explanation: An S3 gallop in heart failure suggests fluid overload and left ventricular failure, commonly found in congestive heart failure.
- A 30-year-old man with no significant medical history presents with acute dyspnea, chest tightness, and a sense of impending doom. He is hyperventilating and has a normal oxygen saturation level. What is the most likely cause of his symptoms?
* A) Asthma
* B) Heart failure
* C) Psychogenic dyspnea
* D) COPD
Answer: C) Psychogenic dyspnea
Explanation: Panic attacks can present with hyperventilation, a sensation of “air hunger,” and a feeling of impending doom, characteristic of psychogenic dyspnea.
