Week Two - Sub-Acute Breathlessness Flashcards
what are the cardiac causes of breathlessness
heart failure
angina/ischaemic heart failure
valvular heart disease
cardiac arrhythmias
what are the respiratory causes of breathlessness
COPD
asthma
interstitial lung disease
breathing pattern disorder
lung cancer
pulmonary vascular disease
what are the mental health causes of breathlessness
anxiety
depression
what are the other causes of breathlessness
obesity
physical deconditioning
anaemia
long COVID
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
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.
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.
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]
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.’
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
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
what is generalised reduced blood flow due to
congestive heart failure
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
what drugs should be considered for heart failure
diuretics, ACE inhibitors, inotropic drugs
what is the range of fever
anything over 38 degrees is high
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
what is the main lower respiratory tract infection
pneumonia
what can an upper respiratory tract infection include
ears, nose, throat and sinuses
what is important differential in a child under 12 months with respiratory infections
bronchiolitis
what are the six main URTI
common cold
sore throat
tonsilitis
acute otitis media
otitis media with effusion
acute sinusitis
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
