SOB Flashcards

1
Q

What is dyspnea?

A

Abnormally uncomfortable awareness of breathing

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2
Q

what is common DDX for dyspnea?

A
CHF
Angina
Obstructive airway Dz
Anemia
Hypothyroid
Metabolic acidosis
Anxiety and hyperventilation
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3
Q

Dyspnea not related to exertion?

A

Sudden episode at rest

  • PE
  • Pneumothorax
  • Anxiety
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4
Q

What is orthopnea and its ass?

A

Dyspnea when supine

- CHF, ashthma and COPD

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5
Q

What is paroxysmal nocturnal dyspnea (PND)? Ass?

A

Waking at night from SOB

- CHF and COPD

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6
Q

What is Trepopnea and its ass?

A

Dyspnea when lying on side

- CHF

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7
Q

What are the receptors involved for dyspnea that relay to brainstem respiratory centers?

A
  1. Chemoreceptors
    - Co2, O2 and pH
  2. Stretch receptors
  3. Intrathoracic receptors
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8
Q

What is CHF?

A

Syndrome of dyspnea on exertion, edema of lungs or extremities and fluid retention resulting from cardiac dysfunction

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9
Q

What is high output failure?

A

Persistent high CO that eventually results in ventricular dysfunction

Caused by anemia, beriberi, thyrotoxicosis , pregnancy and AV fistulas

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10
Q

Systolic vs diastoli dysfunction?

A

Systolic is ventricular contractile dysfunction caused by CAD, HTN, Dilated congestive cardiomyopathy (Viral, ETOH, B-blockers and Ca blockers)

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11
Q

Systolic vs diastoli dysfunction?

A

Diastolic is prolonged ventricular realization time and resistance to filling (ventricular stiffness) caused by HTN and increased Age

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12
Q

What is BNP?

A

B-Types natriuretic peptide
- Neurohormone secreted from the cardiac Ventricles in response to volume expansion and pressure overload

Helps diff CHF from other causes of dyspnea

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13
Q

What are the sx of HF?

A
Dyspnea L
Orthopnea L
PND L
Fatigue L and R
Weakness L and R
Leg Edema R
Abdominal fullness R
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14
Q

What are the examine findings in CHF?

A
  • Lung crackles
  • Dullness to percussion of lung bases
  • Elevated JVD
  • Positive hepatojugular reflux
  • S3 and MR
  • Ankle edema
  • Hepatomegaly and ascites
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15
Q

What er the New york heart ass function classification of CHF?

A
  • Class I – no limitation of physical activity
  • Class II – slight limitation. Comfortable at rest, dyspnea or fatigue with activity
  • Class III – marked limitation with physical activity, comfortable at rest
  • Class IV – symptoms at rest, unable to carry on any physical activity without symptoms
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16
Q

How does one dx CHF?

A
  • PE
  • CXR (cardiomeg, Pulmonary venous congestio nand pleural effusions)
  • ECG rule out MI
  • Echo (decrease LV function
  • Stress testing or coronary angiography
17
Q

How does one treat CHF?

A

Fix

  • preload
  • Myocardial contractility
  • Afterload
18
Q

How doe we treat preload in CHF?

A

Diuretics like furosemide and ethacrynic acid

- Vasodilators like isosorbide, Nitro and nesiritide

19
Q

How does one treat myocardial contractility of CHF?

A

Digoxin (oral)
Dobutamine (IV only)
Milrione (IV only)

20
Q

Afterload treatment for CHF?

A

Arterial vasodilators like apresoline

  • ACE inhibitors
  • Angioreceptor II receptors blockers
21
Q

Neurohumeral treatment for CHF?

A

Spironolactone

Carvedilol

22
Q

What is Natrecor or nesiritide?

A

for stage IV HF to improve dyspnea and major SE is HoTN

- Treat BNP

23
Q

How do we treat diastolic dysfunction?

A

Diuretic and vasodilators are contraindicated

  • Ace inhibitors
  • B-blockers
24
Q

What is the subset of increase cap pressure?

A
  • vena cava obstruction
  • deep venous obstruction
  • right atrial HTN
25
Q

What is the subset of reduced lymphatic clearance?

A

Lymphatic obstruction

26
Q

What is the subset of decreased cap oncotic pressure?

A

Malnutrition

Liver/renal/GI dz

27
Q

What is the subset of increase cap permeability?

A

Ca channel blockers

Idiopathic cyclic edema