Shortness of Breath during ExertionFatima AlAwadh
Summarize the case ( Signs & Symptoms & Findings).
Define Dyspnea. Demonstrate the Differential Diagnosis. Display the Anatomy of the Respiratory
Tract. Recognize the Volumes of the Lung. Clarify the Physiology of Breathing. Understand the Pathophysiology of Dyspnea. Mention the Diagnostic Investigations. Enumerate First Aids & Treatments.
Objectives
67-year-old man. Smoke two packs of cigarettes a day.
Stopped smoking six years ago.
Retired coffee salesman.
Married. No pets.
Drinks little alcohol. No other illnesses.
Case
Shortness of breath due
to effort.
Trouble breathing while sitting still.
Productive cough with green sputum.
Looks pale, feels as his temperature is raised.
No shivers, sore throat, vomiting, diarrhea, and not sick.
Case Signs & Symptoms
Thin with broad chest
Moderate SOB
Trachea is positioned in the midline
Thorax moves up &
down symmetrical
ly
Breathing rate is 32 per min
Reduced breath sound
across lung
Wheezing on
expiration
Case Findings on Physical Examination
Extended expiration
BP 132/78 mmHg
Heart rate 94 per min
Arterial oxygen
saturation 91%
Decreased FVC & FEV1
Increase TLC, FRC &
RV
Case Findings on Physical Examination
Dyspnea, the sensation of breathlessness or inadequate breathing, is the most common complaint of patients with cardiopulmonary diseases.
Dyspnea - common complaint “shortness of breath”.
Defined as uncomfortable breathing. Dyspnea on exertion is excessive or
abnormal shortness of breath on exertion.
Dyspnea
Four general categories:
Differential Diagnosis
Cardiac Pulmonary
Mixed cardiac
or pulmonar
y
non-cardiac
non-pulmonar
y
Pulmonary Etiology
COPD AsthmaRestrictive
Lung Disorders
Hereditary Lung
Disorders
Pneumonia
Pneumo-thorax
Congestive Heart Failure
(CHF)
Coronary Artery
Disease (CAD)
Recent or past history
of Myocardial Infarction (MI)
Cardiomyopathy
Cardiac Etiology
Valvular dysfunction
Left ventricular
hypertrophyPericarditis
Arrhythmias
COPD with pulmonary HTN and/or
cor pulmonale
Deconditioning
Chronic pulmonary emboli
Pleural effusion
Mixed Cardiac/Pulmonary Etiology
Metabolic conditions (e.g. acidosis) Pain Trauma
Noncardiac or Nonpulmonary Etiology
Neuromuscular disorders
Functional (anxiety, panic, hyperventilation)
Chemical exposure
Anatomy Respiratory Tract
Pulmonary Volumes & Capacities
The tidal volume
• the volume of air inspired or expired with each normal breath (about 500 ml).
The inspiratory reserve volume
• the extra volume of air that can be inspired over and above the tidal volume with full force (about 3000 ml).
The expiratory reserve volume
• the maximum extra volume of air that can be expired by forceful expiration after end of tidal expiration (about 1100 ml).
The residual volume
• the volume of air remaining in the lungs after the most forceful expiration (about 1200 ml).
Pulmonary Volumes
The inspiratory capacity
• The amount of air a person can breathe in (about 3500 ml).
The functional residual capacity
• The amount of air remains in the lungs after normal expiration (about 2300 ml).
The vital capacity
• The maximum amount of air that can be expelled after first filling the lungs to maximum and expiring to maximum (about 4600 ml).
The total lung capacity
• The maximum volume to which the lungs can be expanded with the greatest possible effort (about 5800 ml).
Pulmonary Capacities
Physiology of Breathing
The pathophysiology is poorly understood.
There are no specialized receptors for dyspnea.
Recent MRI studies have identified a few specific areas in the midbrain that may mediate perception of dyspnea.
Pathophysiology
Pathophysiology
Dyspnea likely results from the complex interaction between:
chemoreceptor stimulation
(Afferent)
mechanical breathing
abnormalities (Efferent)
perception of those two by
the CNS
Pathophysiology
Dyspnea results when a "mismatch" occurs in CNS
between afferent & efferent signaling.
As the brain receives afferent ventilation information, it is
able to compare it to the current level of respiration by
the efferent signals.If the level of respiration is inappropriate for the body's status then dyspnea might
occur.
Chest radiographs
Electrocardiograph
Screening spirometry
Diagnosis
Diagnosis
In cases where test results inconclusive
complete PFTs
ABGs
Standard exercise treadmill testing or complete cardiopulmonary exercise
testing
Consultation with pulmonologist/cardiologist may be
useful
call local emergency.
Check the airway, breathing, and
pulse.
If necessary, begin CPR.
Loosen any tight clothing.
Help the person use any
prescribed medication
monitor breathing and pulse.
open wounds (esp with air bubbles) in neck or chest must be closed
Bandage the sucking wound
with plastic wrap sealing it except for one corner.
First Aid
DO NOT Do NOT give the person food or drink. Do NOT move the person if there has been a
chest or airway injury, unless it is absolutely necessary.
Do NOT place a pillow under the person's head. This can close the airway.
Do NOT wait to see if the person's condition improves before getting medical help. Get help immediately.
First Aid
The primary treatment is directed at its underlying cause.
Examples if fluid is collecting in the lung, the
fluid may need to be drained to lessen the dyspnea.
Chemotherapy or radiation therapy may shrink a tumor to lessen the dyspnea.
If dyspnea is being caused by an infection, antibiotics may be needed.
Treatment
Bronchodilators open a patient's airways and decrease their dyspnea.
Steroidshelp reduce swelling in the lungs that may be causing the shortness of breath.
Anti-anxiety drugs can help break the cycle of panic that can lead to more breathing difficulties.
Pain medications can make breathing easier.
Pharmacological Treatment
http://www.joshcorwin.com/pa/PAC18%20-%20Emergency%20Medicine/Test%201/DYSPNEA.PPT
http://nursingcrib.com/case-study/asthma-case-study/ Guyton and Hall Textbook of Medical
Physiology http://
sciencscarter08-28.wikispaces.com/Respiratory+System+101
Merck Manual of Diagnosis & Therapy http://en.wikipedia.org/wiki/Dyspnea#Treatment http://www.umm.edu/ency/article/000007trt.htm http://
www.valleyhealthlink.com/Taxonomy/RelatedDocuments.aspx?id=0&sid=0&ContentTypeId=34&ContentID=21274-1
References
Thanks
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