Flashcards in Approach to acute breathlessness Deck (28):
1
Causes of breathlessness categories
Respiratory airways
Parenchymal
Pulmonary circulation
Chest wall and pleura
Cardiovascular
Anemia
Non cardiorespiratory
2
Airways disease causes
COPD
Asthma
Bronchitis
Bronchiectasis
CF
Laryngeal/pharyngeal/bronchial Ca
3
Parenchymal disease
ILD
Infections
ARDS
Pneumothorax
Pneumoconiosis
4
Pulmonary ciruclation
Pulmonary embolism
Chronic thromboembolic pulmonary HTN
AV malformation
5
Chest wall and pleura
Effusion
Tumor
Fractured ribs
AS
Kyphoscolosis
NM disorders
6
Cardiac causes
LVF
MVD
Cardiomyopathy
Pericardial effusion or constrictive pericarditis
7
Non cardio-respiratory
Psychogenic
Acidosis
Hypothalmic
Thyroid
Ascites
Stoke
Normal ageing, deconditioning
GORD
8
Questions to ask breathless
How long?
Exercise?
PND/Orthopnea?
Heart or lung?
Fever?
Smoker?
Tightness in chest?
Wheezy at night
Difficulty getting breath
Painful?
Come on suddenly
9
Conditions causing life threatening acute breathlessness
PE
MI
CCF
Pneumothorax
Anaphylaxis
Pulmonary edema
Tamponade
Acute asthma
10
Subacute definitiona and causes of breathlessness
Acute asthma
Acute COPD
Pulmonary edema
Infections
Metabolic acidosis
11
Chronic definition and causes
CCF
COPD
ILD
Valvular
Anemia
Fibrosis
Pulmonary vascular/hypertensive disease
12
Associated symptoms to enquire about
Fever- infection
Central chest pain- MI, PE, pulmonary embolism, pleurisy
Palpitations-paroxysmal tachyA, PE, valvular, HA, anxiety
Syncope
Wheezing
Change in voice-pneumomediastinum, GORD, AA, lung cancer
Hemoptysis- bronchitis, bronchiectasis, malignancy, vasculitis, infection, PE
Dysphagia- laryngitis, epiglotitis
Muscle weakness, myalgia
Bone pain
Anxiety
13
Define orthopnea, platypnea, trepopnea
Orthop- dysP while supine, improves in upright
Platyp- dysP on assuming upright->typical in patent foramen ovale, abominal muscle deficiency or hepatopulmonary syndrome
TrepoP- infrequent, breathlessness in left lateral position, associated with CHF
14
What might dyspnea in pregnant patient indicate
An undiagnosed medical condition-> VHD, pulmonary HTN, alpha 1 protease deficiency, PE, pneumothoraz, AV malformation
If in recent labour- may indicate PE, sepsis/shock, amniotic fluid/trophoblastic embolism
15
Other past history important
Prgenancy
Obesity
Rheumatological disorders
Autoimmune
Malignancies
Penumonia
GORD
TB
Heart failure
Radiation
ETT/ventilation
16
Physical examination- general findings to look for
MSE changes
Sighing
Cyanosis- COPD, PE, airway obstruction, drug toxicity, Congenital heart disease, valves, tamponade
Jaundice- liver failure, lepto
Goitre
Kyphoscoliosis
Clubbing
+Abdominal girth- CHF, cirrhosis, effusions, constrictive pericarditis
Urticarial rash- anaphylaxis
17
Other components of examination for dyspnea
CV exam
- +JVP in CHF, COPD, constrictive pericarditis, pneumothorax
-S3
-edema
Respiratory examination
Neurological examination->MG, myotonic dystrophy, botulism
18
What findings when pericardial effusion and pericardial constriction
Elevated neck veins, pulsus paradoxus, pericardial knock, pericardial rub, Kussmauls
19
Investigations to order
Pulse oximetry- evaluation of hypoxemia
ABG
FBC
Sputum culture
CXR
ECG
Troponins
PEFR
UEC
LFTs
Kidney function
BNP
Echo
Pulmonary function tests
Spirometry
Highr resolution CT scan
V/Q
20
ABG purpose, findings
Hypercapnia
- COPD
-Stroke
-Airway obstruction
-Obesity hypoventilation
Hypocapnia
-Anxiety
-PE
Hypoxemia
shunting (acute respiratory distress syndrome, pneumonia, pulmonary oedema, cyanotic valvular disease),
V/Q mismatching (COPD, asthma, pulmonary embolism), diffusion impairment (interstitial lung disease), or hypoventilation (COPD exacerbation, neuromuscular disease, stroke, upper airway obstruction, or obesity-hypoventilation syndrome)
21
Hypoxemia mechanism categories
shunting (acute respiratory distress syndrome, pneumonia, pulmonary oedema, cyanotic valvular disease), V/Q mismatching (COPD, asthma, pulmonary embolism), diffusion impairment (interstitial lung disease), or hypoventilation (COPD exacerbation, neuromuscular disease, stroke, upper airway obstruction, or obesity-hypoventilation syndrome)
22
FBC findings
Leukocytosis
-Infection
-Sepsis
-Autoimmune
Eosinophilia
-parasite
-vasculitides
-asthma
-cocaine
Anemia- as primary reason
Lymphocytopenia
- Viral
-Chemotherapy
23
Electrolyte findings
Hyponatremia
-CCF
-CKD
-Liver failure
-Hypothyroid
24
LFT findings
Bilirubin +
-Liver
-CCF
-Leptospirosis
Transaminases
-Liver failure-MI
-Atypical pneumonia
25
Kidney function findings
Renal insufficiency->metabolic acidosis causing dyspnea
26
BNP
Associated with CCF
Also
-Sepsis
-CAD
-PE
-COPD w/ cor pulmonale
-Renal failure
-Liver cirrhosis
-Hyperthyroid
27
What does pulmonary function involve
Spirometry
Measuring lung volumes
Evaluating DLCO
28