Week Two - Sub-Acute Breathlessness Flashcards by Rosa Birt

what are the cardiac causes of breathlessness

heart failure
angina/ischaemic heart failure
valvular heart disease
cardiac arrhythmias

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what are the respiratory causes of breathlessness

COPD
asthma
interstitial lung disease
breathing pattern disorder
lung cancer
pulmonary vascular disease

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what are the mental health causes of breathlessness

anxiety
depression

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what are the other causes of breathlessness

obesity
physical deconditioning
anaemia
long COVID

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what is Eisenmenger’s syndrome

describes the reversal of a left-to-right shunt in a congenital heart defect due to pulmonary hypertension

this occurs when an uncorrected left-to-right leads to remodelling of the pulmonary microvasculature, eventually causing obstruction to pulmonary blood and pulmonary hypertension

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what is central cyanosis

Central cyanosis is a generalized bluish discoloration of the body and the visible mucous membranes, which occurs due to inadequate oxygenation secondary to conditions that lead to an increase in deoxygenated hemoglobin or presence of abnormal hemoglobin.

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what is peripheral cyanosis

Peripheral cyanosis is the bluish discoloration of the distal extremities (hands, fingertips, toes), and can sometimes involve circumoral and periorbital areas. Mucous membranes are generally not involved. Peripheral cyanosis is rarely a life-threatening medical emergency. However, it is essential to determine the underlying cause and its timely management to prevent potential complications.

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what is differential cyanosis

Differential cyanosis is the asymmetrical bluish discoloration between the upper and lower extremities. It usually indicates serious underlying cardiopulmonary conditions.[3]

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what is pseudo cyanosis

The bluish discoloration despite adequate oxygenation is sometimes seen due to the ingestion of drugs, toxins, or metals. This is called ‘Pseudocyanosis.’

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what are the causes of central cyanosis

Hypoventilation due to conditions affecting the central nervous system, such as intracranial hemorrhage, tonic-clonic seizures, and heroin overdose.

Pulmonary causes leading to ventilation-perfusion mismatch and impaired alveolar-arterial diffusion, for instance, bronchospasm (asthma), pulmonary embolism, pneumonia, bronchiolitis, pulmonary hypertension, hypoventilation, and COPD[6][7][8]

Cardiovascular causes include heart failure, congenital heart diseases (right to left shunting), and valvular heart diseases.

Hemoglobinopathies including methemoglobinemia, sulfhemoglobinemia

Polycythemia

High altitude

Hypothermia

Obstructive sleep apnea

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what are the causes of peripheral cyanosis

Reduced cardiac output secondary to heart failure or shock

Local vasoconstriction due to cold exposure, hypothermia, acrocyanosis, and Raynaud phenomenon

Vasomotor instability

Arterial obstruction causing regional ischemia secondary to peripheral vascular disease. Causes include atherosclerosis, Buerger disease, atheroembolism

Venous stasis or obstruction, such as in deep vein thrombosis

Hyperviscosity attributable to multiple myelomas, polycythemia, and macroglobulinemia

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what is generalised reduced blood flow due to

congestive heart failure

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how is peripheral cyanosis characterised

Localized cyanosis affecting only extremities

Pink tongue as mucous membranes are almost never involved

Cold extremities as compared to warm extremities in central cyanosis

Clubbing is absent

Pulse volume usually low

Capillary refill time more than 2 sec

Disappears with massage and warming

Dyspnea usually absent

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what drugs should be considered for heart failure

diuretics, ACE inhibitors, inotropic drugs

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what is the range of fever

anything over 38 degrees is high

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what infections causes fever

respiratory tract infections and colds

flu

infection of the gut (gastroenteritis)

ear infections

infections of the tonsils

UTI and kidney infections

DVT and PE

rheumatoid arthritis and lupus

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what is the main lower respiratory tract infection

pneumonia

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what can an upper respiratory tract infection include

ears, nose, throat and sinuses

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what is important differential in a child under 12 months with respiratory infections

bronchiolitis

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what are the six main URTI

common cold

sore throat

tonsilitis

acute otitis media

otitis media with effusion

acute sinusitis

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what is the cause of the common cold

Viral. Most commonly rhinovirus, but may also be coronavirus and RSV.

what is the normal presentation of the common cold

colourless nasal discharge and a blocked nose

what is the treatment for the common cold

It is a self limiting infection

antibiotics are of no use due to viral nature of the infection

what is the cause of a sore throat - pharyngitis

usually viral

B-haemolytic streptococcus may be present

what are the causes of tonsillitis

2/3 of cases are viral (e.g. EBV) and 1/3 are bacterial (e.g. β-haemolytic streptococcus).

what are the symptoms of tonsillitis

May have tonsilar exudates Headache Abdominal pain Fever Cervical lymphadenopathy Lethargy

what should be avoided in tonsillitis treatment and why

amoxicillin should be avoided - as can cause macuopapular rash if tonsillitis is due to infectious mononucleosis (EBV)

what are the causes of acute otitis media

Many cases are viral, including RSV and rhinovirus. Bacterial causes are usually haemophilus influenzae and Moraxella catarrhais.

what are the symptoms of acute otitis media

Fever Ear pain Child may tug at affected ear Otoscopic findings: red, inflamed tympanic membrane. Loss of light reflex

what is the recommended antibiotic for acute otitis media

amoxicillin

what is OME - glue ear

Caused by recurrent otitis media. Very common at <1 years age. Persists up to around 10 years of age.

what are the symptoms of OME

Hearing loss on affected side Other symptoms (e.g. pain) are rare Tympanic membrane may be dull and retracted. Flud level may be visible

what is the cause of acute sinusitis

usually viral, occasionally bacterial

what are the symptoms of sinusitis

Pain Swelling Tenderness (all over zygomatic/cheek region)

how is sinusitis treatment

symptom relief with paracetamol and ibuprofen

what is ARDS

acute respiratory distress syndrome

what is ARDS a result of

essentially acute lung inflammation as a result of sepsis, pneumonia, trauma or aspiration

what is the pathology behind ARDS

results from local or systematic inflammatory processes. cytokines and other inflammatory mediators recruit macrophages and neutrophils to the area these WC's then release other inflammatory agents, and there is a disruption of the boundary between lung tissue and normal capillaries. there is reduced lung compliance and disruption of surfactant leading to collapse of airways

how can you differentiate between ARDS and acute heart failure

by taking a pulmonary wedge pressure measurement

what are the signs and symptoms of ARDS

Dyspnoea Tachycardia Tachypnoea Bilateral Basal crepitations / other abnormal breath sounds Chest pain Peripheral vasodilation

what is the diagnostic criteria for ARDS

Acute onset PCWP – pulmonary capillary wedge pressure – <19mmHg CXR – demonstrating bilateral diffuse infiltrates Refractory hypoxaemia – PO2:FiO2 <200 (Total thoracic compliance <30ml/cm H2O) – helpful but not necessary to fulfil diagnostic criteria

what are the bloods done for ARDS

amylase, FBC, U+E, CRP ESR is not generally useful as it measures chronic inflammation

what would an ABG show

Low O2 – often does not respond well to prescribed O2 pH – can be low initially (due to respiratory acidosis), or may be high in the presence of sepsis, or as a result of the underlying cause of ARDS

what pressure is required in pulmonary capillary wedge pressure to consider ARDS as a diagnosis

<19mmHg

what combats high intrapulmonary pressures

inhaled nitric oxide

what is the other name for salbutamol

Ventolin

what is the other names for formoterol

Oxis, foradile, foradil, atock

how much of an inhaled dose actually makes it into the lungs

15%

what are the unwanted effects of inhalers

Fine tremor – this may be present if a patient is on a high dose of these for a long period. It is unlikely that inhaler use alone will cause this, and it most common occurs in patients who are taking nebulized forms of the drugs. This results from β2 stimulation Tachycardia and arrhythmia can result when high doses are taken. This is a result of β1 and β2 stimulation Headache Bronchospasm can sometimes occur the first time the drug is taken. Oral candidiasis can occur when the drugs are used long term. Some practicioners recommend to rinse the mouth and spit after the inhaler is used to reduce the likelihood of this. Acute metabolic responses – these will not persist long-term, but initially can include hypokalaemia, hypomagnesaemia and hyperglycaemia. Tolerance can occur if you overuse them. Protein kinase A (one of the proteins activated in the 2nd messenger system) attacks the β2 receptor and uncouples it from its G-protein, meaning that activation of the receptor will not result in activation of the 2nd messenger system.

what is the usual inhaled dose of salbutamol

100ug

what is the main symptomatic difference between lower and upper Respiratory tract infections

People who have lower respiratory tract infections will experience coughing as the primary symptom. People with upper respiratory tract infections will feel the symptoms mainly above the neck, such as sneezing, headaches, and sore throats. They may also experience body aches, especially if they have a fever