SPECIFIC TYPES OF SPECIFIC TYPES OF DYSPNEADYSPNEA

PAROXYMAL NOCTURNAL DYSNPNEAPAROXYMAL NOCTURNAL DYSNPNEAORTHOPNEAORTHOPNEATREPOPNEATREPOPNEAPLATYPNEA PLATYPNEA

PAROXYMAL NOCTURNAL PAROXYMAL NOCTURNAL DYSPNEADYSPNEA

Also known as CARDIAC ASTHMAAlso known as CARDIAC ASTHMA

Characterized by attacks of severe Characterized by attacks of severe shortness shortness

of breath that occur at night and of breath that occur at night and usuallyusually

awakens the patient from sleepawakens the patient from sleep

MechanismMechanismReabsorption of edema from dependent position of bodyReabsorption of edema from dependent position of body

Increase in total blood volumeIncrease in total blood volume

Increased pulmonary venous pressureIncreased pulmonary venous pressure

Thickening of the walls of pulmonary vesselsThickening of the walls of pulmonary vessels

Competition of space among vessels, airways & increased fluid in Competition of space among vessels, airways & increased fluid in interstitial space interstitial space

Compression of small airway Compression of small airway

Increased airway resistance Increased airway resistance

Increased work of breathingIncreased work of breathing

DyspneaDyspnea

Nocturnal dyspnea forms Nocturnal dyspnea forms

o Nocturnal dyspnea in chronic bronchitisNocturnal dyspnea in chronic bronchitis characterised by hypersecretion of characterised by hypersecretion of

mucus and production of wheezing mucus and production of wheezing o Nocturnal dyspnea in asthmaNocturnal dyspnea in asthma Severe between 2am and 4am in the Severe between 2am and 4am in the

morning morning Patient wakes up with sense of Patient wakes up with sense of

suffocationsuffocation

,extreme dyspnea and wheezing ,extreme dyspnea and wheezing

ORTHOPNEAORTHOPNEA

Dyspnea that occurs in supine position Dyspnea that occurs in supine position The cause is the effect of gravitational The cause is the effect of gravitational

forces that elevates the pulmonary venous forces that elevates the pulmonary venous and capillary pressureand capillary pressure

Seen in cases of Seen in cases of CHFCHF Severely obese individualSeverely obese individual Bilateral phrenic nerve palsyBilateral phrenic nerve palsy Diaphragmatic disorder Diaphragmatic disorder

TREPOPNEATREPOPNEA

Dyspnea that is relieved when the Dyspnea that is relieved when the patient is in lateral recumbent patient is in lateral recumbent positionposition

PLATYPNEAPLATYPNEA

Dyspnea that occurs only in upright Dyspnea that occurs only in upright positionposition

Seen in cases ofSeen in cases of Chronic liver diseaseChronic liver disease Pulmonary arteriovenous metastasisPulmonary arteriovenous metastasis

ACCORDING TO TIME AND ACCORDING TO TIME AND CHRONICITYCHRONICITY

INSTANTANEOUS:INSTANTANEOUS: PneumothoraxPneumothorax Pulmonary Pulmonary

embolismembolism

• Acute (minutes - Acute (minutes - hrs):hrs):

Metabolic acidosisMetabolic acidosis Cardiac diseaseCardiac disease Hyperventilation Hyperventilation

syndromesyndrome

Subacute(days):Subacute(days): Pleural effusionPleural effusion Lobar collapseLobar collapse SVC obstructionSVC obstruction Acute interstitial pneumoniaAcute interstitial pneumonia

Chronic (mon-years):Chronic (mon-years): COPDCOPD Bronchial asthmaBronchial asthma SarcoidosisSarcoidosis BronchiectasisBronchiectasis AnemiaAnemia ObesityObesity ThyrotoxicosisThyrotoxicosis

DIFFERENTIAL DIAGNOSISDIFFERENTIAL DIAGNOSIS

The first aim of diagnosis is to The first aim of diagnosis is to differentiate between two main types differentiate between two main types of dyspneaof dyspnea

ACUTE DYSNEAACUTE DYSNEA

CHRONIC EXERTIONAL DYSPNEACHRONIC EXERTIONAL DYSPNEA

Acute severe dyspneaAcute severe dyspnea

CONDITIONCONDITION HISTORYHISTORY SIGNSSIGNS CHEST CHEST RADIOGRAPHYRADIOGRAPHY

ARTERIAL ARTERIAL BLOOD BLOOD GASESGASES

ECGECG

Pulmonary Pulmonary edemaedema

Chest painChest pain

OrthopneaOrthopnea

palpitationspalpitations

Central cyanosisCentral cyanosis

Jvp^Jvp^

sweatingsweating

CardiomegalyCardiomegaly

Plueral effusionPlueral effusion

Overt edemaOvert edema

Pao2 vPao2 v

Paco2 vPaco2 vSinus Sinus tachycarditachycardiaa

Signs of MISigns of MI

Massive Massive pulmonary pulmonary embolusembolus

Recent surgeryRecent surgery

Chest painChest pain

dizzinessdizziness

Central cyanosisCentral cyanosis

^jvp^jvp

trachycardiatrachycardia

Subtle changes Subtle changes onlyonly

Pao2 vvPao2 vv

Paco2 vPaco2 vSinus Sinus tachycarditachycardiaa

Acute severe Acute severe asthmaasthma

WheezeWheeze

Previous Previous episodesepisodes

TachycardiaTachycardia

JvpJvp

rhonchirhonchi

Hyperinflation Hyperinflation onlyonly

Pao2 vPao2 v

Paco2 vPaco2 vSinus Sinus tachycarditachycardiaa

Acute Acute exacerbation exacerbation of COPDof COPD

Previous Previous episodesepisodes

CyanosisCyanosis

Signs of COPD and Signs of COPD and co2 retentionco2 retention

HyperinflationHyperinflation

Signs of Signs of emphysemaemphysema

Pao2 v Pao2 v

Paco2 ^Paco2 ^

^bicarbonat^bicarbonatee

Signs of Signs of right right ventricle ventricle strainstrain

pneumoniapneumonia FeverFever

RigorsRigors

pleurisypleurisy

FeverFever

ConfusionConfusion

Pleural rubPleural rub

consolidationconsolidation

Pneumonic Pneumonic consolidationconsolidation

Pao2 vPao2 v

Paco2 vPaco2 vtachycarditachycardiaa

Metabolic Metabolic acidosisacidosis

Evidence of Evidence of renal or renal or diabetesdiabetes

Over dose of Over dose of aspirinaspirin

FetorFetor

HyperventilationHyperventilation

DehydrationDehydration

Kussumaul’s Kussumaul’s respirationrespiration

normalnormal Pao2 normalPao2 normal

Paco2 vvPaco2 vv

pH vvpH vv

psychogenicpsychogenic Previous Previous episodesepisodes

Not cyanosedNot cyanosed

No heart signsNo heart signs

No lung signsNo lung signs

normalnormal Pao2 normalPao2 normal

Paco2 vvPaco2 vv

pH >^pH >^

CHRONIC EXERTIONAL CHRONIC EXERTIONAL DYSPNEADYSPNEA

COPDCOPDChronic asthmaChronic asthmaHeart diseaseHeart disease Interstitial or alveolar disease of lungInterstitial or alveolar disease of lungDisease of chest wall or respiratory Disease of chest wall or respiratory

musclesmusclesPulmonary thromboembolismPulmonary thromboembolism