SOB Flashcards
What is dyspnea?
Abnormally uncomfortable awareness of breathing
what is common DDX for dyspnea?
CHF Angina Obstructive airway Dz Anemia Hypothyroid Metabolic acidosis Anxiety and hyperventilation
Dyspnea not related to exertion?
Sudden episode at rest
- PE
- Pneumothorax
- Anxiety
What is orthopnea and its ass?
Dyspnea when supine
- CHF, ashthma and COPD
What is paroxysmal nocturnal dyspnea (PND)? Ass?
Waking at night from SOB
- CHF and COPD
What is Trepopnea and its ass?
Dyspnea when lying on side
- CHF
What are the receptors involved for dyspnea that relay to brainstem respiratory centers?
- Chemoreceptors
- Co2, O2 and pH - Stretch receptors
- Intrathoracic receptors
What is CHF?
Syndrome of dyspnea on exertion, edema of lungs or extremities and fluid retention resulting from cardiac dysfunction
What is high output failure?
Persistent high CO that eventually results in ventricular dysfunction
Caused by anemia, beriberi, thyrotoxicosis , pregnancy and AV fistulas
Systolic vs diastoli dysfunction?
Systolic is ventricular contractile dysfunction caused by CAD, HTN, Dilated congestive cardiomyopathy (Viral, ETOH, B-blockers and Ca blockers)
Systolic vs diastoli dysfunction?
Diastolic is prolonged ventricular realization time and resistance to filling (ventricular stiffness) caused by HTN and increased Age
What is BNP?
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
What are the sx of HF?
Dyspnea L Orthopnea L PND L Fatigue L and R Weakness L and R Leg Edema R Abdominal fullness R
What are the examine findings in CHF?
- Lung crackles
- Dullness to percussion of lung bases
- Elevated JVD
- Positive hepatojugular reflux
- S3 and MR
- Ankle edema
- Hepatomegaly and ascites
What er the New york heart ass function classification of CHF?
- 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
How does one dx CHF?
- PE
- CXR (cardiomeg, Pulmonary venous congestio nand pleural effusions)
- ECG rule out MI
- Echo (decrease LV function
- Stress testing or coronary angiography
How does one treat CHF?
Fix
- preload
- Myocardial contractility
- Afterload
How doe we treat preload in CHF?
Diuretics like furosemide and ethacrynic acid
- Vasodilators like isosorbide, Nitro and nesiritide
How does one treat myocardial contractility of CHF?
Digoxin (oral)
Dobutamine (IV only)
Milrione (IV only)
Afterload treatment for CHF?
Arterial vasodilators like apresoline
- ACE inhibitors
- Angioreceptor II receptors blockers
Neurohumeral treatment for CHF?
Spironolactone
Carvedilol
What is Natrecor or nesiritide?
for stage IV HF to improve dyspnea and major SE is HoTN
- Treat BNP
How do we treat diastolic dysfunction?
Diuretic and vasodilators are contraindicated
- Ace inhibitors
- B-blockers
What is the subset of increase cap pressure?
- vena cava obstruction
- deep venous obstruction
- right atrial HTN
What is the subset of reduced lymphatic clearance?
Lymphatic obstruction
What is the subset of decreased cap oncotic pressure?
Malnutrition
Liver/renal/GI dz
What is the subset of increase cap permeability?
Ca channel blockers
Idiopathic cyclic edema
