Transcript SHORTNESS OF BREATH

Dr Arjan Verdi
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The subjective symptom of breathlessness
Essentially means that the body is not getting
enough oxygen thus there is a increase in
respiratory drive
1)Decrease O2 into the
lungs
•Obstruction: lung Ca,
COPD, asthma,
anaphylaxis
•Lung compliance:
restrictive lung diseasefibrosis
•Lung space:
pneumothorax, collapse
•Diaphragm: Guillain
Barre syndrome,
myasthenia gravis
•Chest wall: obesity,
kyphoscoliosis
2) Ventilationperfusion mismatch
•Pulmonary oedema: HF,
liver failure, nephrotic
syndrome
•Pneumonia
•PE
Pulomary fibrosis
3) Reduced oxygen
transport
•Reduced cardiac output:
aortic stenosis, heart
failure
•Anaemia
•Shock: haemorrhage,
sepsis
4)Other causes
•Hyperventilation
•Acidaemia (DKA)
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Speed onset
 Seconds to minutes: anapylaxis, PE, pneumothorax,
flash pulmonary oedema, hyperventilation
 Hours to day: pneumonia, heart failure, pleural
effusion,
 Weeks to months: COPD, asthma, heart failure,
fibrosis, anaemia,
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Cough?
 Persistent productive cough last few days ?pneumonia;
few months in a smoker ?COPD
 Dry cough at night ? Asthma
 Pink frothy sputum ? Heart failure
 Blood stained ?PE, pneumonia, brochiectasis, lung
cancer
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Chest pain
 Is it pleuritic ?pneumonia, pneumothorax, PE
 Non- pleuritic ? CVS pathology
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Red flag symptom
 Weight loss, anorexia, night sweats- ?
Cancer or TB
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Alleviating/exacerbating symptoms:
 Heart failure- orthopnoea
 Asthma worse in summer/ dust
 COPD worse in winter
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Risk factors
 Smoking: pack years?
 Pets: allergies, psittacosis
 Occupation: asbestos, silica, dust, coal
 Medication: amiodarone, methotrexate,
cyclophosphamides, bleomycin,
hydralazine, busulphan can cause
pulmonary fibrosis
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Lower respiratory tract infection
Symptoms: fever, rigors, sputum ,SOB,
haemoptysis,
Signs: tachycardic, tachpnoeic , confused,
reduced expansion, dull percussion, increase
tactile vocal fremitus, bronchial breathing
Test; ABG, CXR, Sputum culture, bloods
Mx: IVI’s. Abx, analgesia , oxygen
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Obstruction of the airways with little/ no
reversibility
SMOKING
Chronic bronchitis: a productive cough for
everyday for 3 months for 2 consecutive
years
Symptoms: cough, sputum, dyspnoea,
wheeze
Signs: hyper expanded chest, pursed lipped
breathing, reduced chest expansion and
hyper resonant percusssion
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SOB on exertion, orthopnoea, PND
Risk factors:
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ischaemic heart disease
atherosclerotic disease (TIA, limb claudication)
Hypertension
Valvular disease (rheumatic fever, endocarditis)
Cardiomyopathy
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Displaced apex
Third/fourth heart sounds
Bilateral crackles
Raised JVP, Hepatomegly, peripheral odema
Signs on examination
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Usually from bloods clots in the legs or pelvis
Risk factors:
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Surgery
Stroke and MI
Cancer
Immobility
Obesity
Pregnancy, post partum and HRT
Symptoms: SOB, pleurtic chest pain,
haemoptysis, dizziness, syncope
Signs: tachycardic, tachypnoeic, raised JVP,
pleural rub,
Look at pts legs
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Bloods:
CXR:
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FBC- ?anaemia
WCC and CRP- ?Infection
D-dimer- ?PE
U&E’s- pt dehydrated or fluid overload
 Heart failure- ABCDE
 Pneumonia- consolidation
 Pneumothorax or collapse
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ABG- respiratory failure type 1 or 2
Peak expiratory flow rate: act as a baseline and
grade severity
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Oxford cases in Medicine an surgery by
Farne, Norrise-Cervetto, Warbrick-Smith
Oxford Clinical Medicine by Murray Longmore