Dyspnea

Approach to Dyspnea

Presented by:
Corina Ann Bonus

Perpetual Help Medical Center

Las Pinas
Dyspnea
• Subjective experience of breathing discomfort.
• Difficulty in breathing or Shortness of breath.
• A signs of increased work of breathing.
• Deviations from normal functions in the cardiovascular
and respiratory systems.
Mechanism of DYSPNEA
 Motor Efferent
 Sensory Afferent
1. Chemoreceptors
2. Mechanoreceptors
3. Metaboreceptors
 Efferent-Afferent Mismatch
 Contribution Of Emotional Or Affective Factors To Dyspnea
Mechanism of DYSPNEA
Approach to the patient: DYSPNEA
 Respiratory System Dyspnea
 Disease in the airway
1. COPD
2. Asthma
3. Acute Bronchoconstriction
 Disease of the chest wall
1. Kyphoscoliosis
2. Myasthenia gravis
3. Guillian- Barre syndrome
 Disease in the lung parenchyma
1. Interstitial lung disease-infection, occupational exposure or autoimmune
disorders
Cardiovascular System Dyspnea
 Disease in the Left heart
1. Myocardium->coronary artery disease
non ischemic cardiomyopathies ->
left ventricular end-diastolic volume
elevation of the left ventricular end diastolic pressure->
interstitial edema
stimulation of pulmonary receptors->
dyspnea.
2. Diastolic dysfunction
 Disease of the pulmonary Thromboembolic disease, pulmonary hypertension and pulmonary vasculitis
 Disease of the Pericardium
1. Constrictive pericarditis
2. Cardiac tamponade
Dyspnea with Normal Respiratory and
Cardiovascular system
Anemia
Obesity
Poor fitness
Common causes of non cardiogenic
pulmonary disease
 Direct injury to lung
1. Chest trauma, pulmonary contusion
2. Aspiration
3. Smoke inhalation
4. Pneumonia
5. Oxygen toxicity
6. Pulmonary embolism, reperfusion
 Hematogenous injury to lung
1. Sepsis
2. Pancreatitis
3. Non thoracic Trauma
4. Leukoagglutination reactions
5. Multiple transfusion
6. Intravenous drug used (e.g., heroin)
7. Cardiopulmonary bypass
 Possible lung injury + Elevated Hydrostatic
Pressures
1. High altitude pulmonary edema
2. Neurogenic pulmonary edema
3. Re expansion pulmonary edema
Upper Airway Foreign Body Obstruction

Pharyngeal Edema
Croup
Epiglottitis
Foreign Body Obstruction Partial or complete

Most common cause of pediatric airway

obstruction
Foreign Body Obstruction

Suspect in any child with Sudden onset of

dyspnea
Decreased LOC
Suspect in any adult who develops dyspnea
or loses consciousness while eating
Pharyngeal Edema

Swelling of soft tissues of throat

Allergic reactions, upper airway burns
Hoarseness, stridor, drooling
Epiglottitis Bacterial infection

Causes edema of epiglottis

Children age 4-7 years
Increasingly common in adults
Rapid onset, high fever, stridor, sore
throat, drooling
Croup Laryngotracheobronchitis

Viral infection
Causes edema of larynx/trachea
Children ages 6 months to 4 years
Lower Airway Asthma
Chronic Obstructive Pulmonary Disease
Chronic bronchitis
Emphysema
Asthma Reversible obstructive pulmonary disease
Younger persons disease (80 have first
episode before age 30)

Lower airway hypersensitive to

allergens, emotional stress, irritants, infection
Asthma Bronchospasm
Bronchial edema
Increased mucus production, plugging
Resistance to airflow, work of breathing increase
Asthma Airway narrowing interferes with
exhalation
Air trapped in chest interferes with gas exchange
Wheezing, coughing, respiratory distress
Asthma
All that wheezes is not asthma

Other possibilities
Pulmonary edema
Pulmonary embolism
Anaphylaxis (severe allergic reaction)
Foreign body aspiration
Pneumonia
Chronic Obstructive Pulmonary Disease
Chronic Bronchitis
Emphysema
Chronic Bronchitis Chronic lower airway
inflammation
Increased bronchial mucus production
Productive cough
Urban male smokers at 30 years old
Chronic Bronchitis Mucus, swelling interfere with
ventilation
Increased CO2, decreased O2
Cyanosis occurs early in disease
Lung disease overworks right ventricle
Right heart failure occurs
RHF produces peripheral edema
Blue Bloater
Emphysema Loss of elasticity in small airways
Destruction of alveolar walls
Urban male smokers at 40-50 years old
Emphysema Lungs lose elastic recoil
Retain CO2, maintain near normal O2
Cyanosis occurs late in disease
Barrel chest (increased AP diameter)
Thin, wasted
Prolonged exhalation through pursed lips
Pink Puffer
COPD Prone to periods of decompensation
Triggered by respiratory infections, chest trauma
Signs/Symptoms
Respiratory distress
Tachypnea
Cough productive of green, yellow sputum
Alveolar Function Problems
Pulmonary Edema Fluid in/around alveoli, small
airways
Causes
Left heart failure
Toxic inhalants
Aspiration
Drowning
Trauma
Pulmonary Edema Signs/Symptoms
Labored breathing
Coughing
Rales, rhonchi
Wheezes
Pink, frothy sputum
Pulmonary Edema Signs/Symptoms
Sit up
High concentration O2
Assist ventilation
Pulmonary Embolism Clot from venous
circulation
Passes through right heart
Lodges in pulmonary circulation
Shuts off blood flow past part of alveoli
Pulmonary Embolism Associated with
Prolonged bed rest or immobilization
Casts or orthopedic traction
Pelvic or lower extremity surgery
Phlebitis
Use of BCPs
Pulmonary Embolism Signs/Symptoms
Dyspnea
Chest pain
Tachycardia
Tachypnea
Hemoptysis
Sudden Dyspnea No Readily Identifiable Cause
Pulmonary Embolism
Pulmonary Embolism Management
Oxygen
Assisted ventilation
Transport