Presentation Flashcards
(41 cards)
How can SOB present as? (time-wise)
Acute; Subacute; Chronic
What are the conditions associated with Acute SOB?
LUNGS:
1) Pulmonary EMbolism
2) Pneumothorax
3) **Respiratory infections (pneumonia)
**
Heart:
1) Acute MI
2) Acute HF
Other:
1) Anaphylaxis that closes Upper airway
Potentially life threatining conditions that require immediate attention
What conditions are related to Chronic Dyspnea?
Heart:
LHF
Lung:
Interstitial Lung Disease
COPD (asthma + Chronic Bronchitis)
Blood: `
Anemia
Other:
Deconditioning
long-standing disease, allowing for compensatory adaptations in the body
Cardiac Causes of SOB
1) LHF
+ Paroxysmal Nocturnal Dysnea
+ Orthopnea when lying down
+ Pulmonary congestion (crackles)
+ S3 Gallop
2) MI/ Infarction
+ Chest Pain (unless silent MI) that radiates
+ MC: Elderly and DM pts
3) Arrhythmias (afib and Tachyarrhythmias)
+Rapid or irregular heart rhythms (atrial fibrillation) reduce cardiac output, leading to shortness of breath and Palpitations
+Tachyarrhythmias would have Rapid HR (decreases Ventricular filling, reducing SV/CO)ysnea
4) Valvular Diseases
AS: Excertional dysnea, angina, and syncope because of Reduced Cardiac Output
MS: Hemptysis, Fatigue from Impared LA outflow
5) Pericardial Effusion and Temponade:
+Decreased Heart filling causing the SOB
+Muffled Heart sounds
+Pulsus Paradoxus
RHF can be caused by LHF and chronic lung disease (cor pulmonale). Signs include perepheral edema, ascites, elevated JVP
Pulmonary Causes of SOB
1) Chronic Bronchitis
+Smokers hx
+Productive cough (3yrs, <2months space between)
+Progressive breathlessness
+Emphysema (trouble breathing due to alveolar wall damage)
2) Asthma:
+Reversible smooth muscle contraction
+Triggered by Cold, Allergens, and exercise.
3) Pneumonia
+Cough with Sputum Production
+Fever
+/- Pain on inspiration
4) PneumoThorax
+ Painful inspiration
+Tall-Thin male (spontaneous)/ Trauma (tramatic Pneumothorax)
+Possible underlying lung disease
5) Pulmonary Embolism:
+Hemoptysis
+Painful inspiration
+Tachychardia
6) Intersitial Lung Disease (pulomary fibrosis, sarcodosis, pneumoconiosis)
+RLD pattern on PFT
+Dry cough
+Trouble Inhaling
Other causes of SOB?
1) Amenia
+Reduced Oxygen Carrying Capacity
2) Metabolic Acidosis
+Diabetic ketoacidosis compensatory hyperventilation (Kussmaul respiration- Rapid and deep)
3) Psychogenic
+Anxiety
+Panic attack/disorder
Notable factors that should be considered in SOB history
OPQRST (Onset, Provocation, Quality, Radiation, Severity, and Timing).
Onset (day- yrs)
Provocation
Quality of breathing sounds
Radiation
Severity (mild/mod/severe)
Timing (quick, gradual)
——————————–
NOTES:
* History: Document onset, duration,
pattern (episodic or persistent),
position (e.g., orthopnea), and associated symptoms (e.g., chest pain, palpitations, fever).
P/E for SOB
General:
Check for pallor (anemia),
Anxiety
Leg swelling (suggesting DVT).
Cardio:
+Elevated JVP
+Perepheral Edema
+S3 Gallop
Lungs:
+Increased Work on Breathing
+Wheeze and Crackles on Breathing
+Percuss for Pneumothorax or Consolidation
Basic Tests for SOB?
ABCDEF
Arterial Blood Gas
BNP
CBC
D-Dimer
EKG
PFT
o Arterial Blood Gas (ABG):
Provides insight into oxygenation, ventilation, and acid-base status.
o B-type Natriuretic Peptide (BNP) or NT-proBNP:
Elevated levels indicate heart failure.
o Complete Blood Count (CBC):
To rule out anemia or infection.
o D-dimer:
Helps rule out PE, especially in low-risk patients.
o Electrocardiogram (ECG):
Can reveal signs of MI, arrhythmias, or PE (e.g., S1Q3T3 pattern).
o Pulmonary Function Tests (PFTs):
For chronic dyspnea to assess obstructive or restrictive lung diseases.
Imaging for SB
1) CXR
2) CT Pulmonary ANgiography
3) Echo
o Chest X-ray: Essential in evaluating pulmonary or cardiac causes, such as pneumonia, pleural effusion, or heart failure.
o CT Pulmonary Angiography: Gold standard for diagnosing PE.
o Echocardiography: Useful for assessing heart failure, valvular disease, or pericardial effusion.
Additinal factors that should be looked at for SOB
pneumonic VINDICATE
(Vascular, Infectious, Neoplastic, Degenerative, Iatrogenic, Congenital, Autoimmune, Trauma, Endocrine) can be helpful to ensure a comprehensive differential has been considered.
- Vascular
- Iatrogenic
- Neoplasm
- Degeneration
- Infection
- Congenital
- Autoimmune
- Tumor
- Endocrine
Immediate Lung treatment for SOB
Add DANO’s spice for that SOB’s Lngsu
Diuretics
ANticoagulants
Nebulizer
Oxygenuretic
- Diuretic if HF related, decrease Blood volume
- Anticoagulant to prevent additional blood clots related to PE or MI
- Nebulizer to open up airways in cases of Asthma and COPD (bronchospasms)
- Oxygen supplemented to increase/maintain oxygen levels (hypoxia)
Condition-Specific Treatments:
HF
Hf is BAD
BB
ACE/ARB
Diuretics (including ALdosterone ANtagonist - K sparing diuretics)
Condition-Specific Treatments:
COPD (asthma/ CB)
BronchoDialators (albuterol), possible corticosteroids for exasturbations
o Bronchodilators (e.g., albuterol) and corticosteroids for exacerbations.
o In stable cases, long-acting bronchodilators and inhaled corticosteroids help control symptoms and reduce exacerbations.
Condition-Specific Treatments:
Pulmonary Embolism
ANtiCoagulants to prevent further clots
Thrombolytics to breakdown the embolism
Condition-Specific Treatments:
Pneumonia
ABX (Microbe based)
Condition-Specific Treatments:
Psyc related SOB (Anxiety and panic attacks/disorders)
CBT
SSRI
LHF symptoms
1) LHF
+ Paroxysmal Nocturnal Dysnea
+ Orthopnea when lying down
+ Pulmonary congestion (crackles)
+ S3 Gallop
MI/Infaction symptoms
MI/ Infarction
+ Chest Pain (unless silent MI) that radiates
+ MC: Elderly and DM pts
Arrythmeia symptoms
Arrhythmias (afib and Tachyarrhythmias)
+Rapid or irregular heart rhythms (atrial fibrillation) reduce cardiac output, leading to shortness of breath and Palpitations
+Tachyarrhythmias would have Rapid HR (decreases Ventricular filling, reducing SV/CO)ysnea
Aortic stenosis symptoms
Valvular Diseases
AS: Excertional dysnea, angina, and syncope because of Reduced Cardiac Output
Mitral Stenosis Symptoms
Valvular Heart Disease
MS: Hemptysis, Fatigue from Impared LA outflow
Pericardial Effusion and Temponade: symptoms
Pericardial Effusion and Temponade:
+Decreased Heart filling causing the SOB
+Muffled Heart sounds
+Pulsus Paradoxus
COPD symptoms
1) Chronic Bronchitis
+Smokers hx
+Productive cough (3yrs, <2months space between)
+Progressive breathlessness
+Emphysema (trouble breathing due to alveolar wall damage)
