Download - [Int. med] dyspnoea from SIMS Lahore
![Page 1: [Int. med] dyspnoea from SIMS Lahore](https://reader038.vdocuments.net/reader038/viewer/2022110318/55d2cd21bb61eb744e8b4583/html5/thumbnails/1.jpg)
Dr. Nighat Majeed Dr. Nighat Majeed Assistant professor medicineAssistant professor medicine
Medical unit 11 Medical unit 11 SHL/SIMS LahoreSHL/SIMS Lahore
![Page 2: [Int. med] dyspnoea from SIMS Lahore](https://reader038.vdocuments.net/reader038/viewer/2022110318/55d2cd21bb61eb744e8b4583/html5/thumbnails/2.jpg)
INTRODUCTION
Dyspnea derived , from the word dyspnoos, (shortness of breath) is
perceived to be difficulty of breathing or painful breathing.
• Dyspnea on exertion indicates dyspnea that occurs or worsens during physical
activity.
![Page 3: [Int. med] dyspnoea from SIMS Lahore](https://reader038.vdocuments.net/reader038/viewer/2022110318/55d2cd21bb61eb744e8b4583/html5/thumbnails/3.jpg)
ETIOLOGY
![Page 4: [Int. med] dyspnoea from SIMS Lahore](https://reader038.vdocuments.net/reader038/viewer/2022110318/55d2cd21bb61eb744e8b4583/html5/thumbnails/4.jpg)
Acute dyspnoea• Cardiac causes(Cardiogenic pulmonary
edema).
• Acute attack of bronchial asthma.
• Pulmonary Embolism.
• Spontaneous pneumothorax.
• Pneumonia.
![Page 5: [Int. med] dyspnoea from SIMS Lahore](https://reader038.vdocuments.net/reader038/viewer/2022110318/55d2cd21bb61eb744e8b4583/html5/thumbnails/5.jpg)
Acute dyspnoea
• Adult respiratory distress syndrome.
• Non cardiac pulmonary edema(noxius gas inhalation,high altitude pulmonary edema,neurogenic pulmonary edema).
![Page 6: [Int. med] dyspnoea from SIMS Lahore](https://reader038.vdocuments.net/reader038/viewer/2022110318/55d2cd21bb61eb744e8b4583/html5/thumbnails/6.jpg)
Acute dyspnoea
• Massive pleural effusion.
• Foreign body aspiration.
• Acute hyperventilation syndrome(neuropsychiatric).
• Metabolic acidosis.
![Page 7: [Int. med] dyspnoea from SIMS Lahore](https://reader038.vdocuments.net/reader038/viewer/2022110318/55d2cd21bb61eb744e8b4583/html5/thumbnails/7.jpg)
Chronic Dyspnoea
![Page 8: [Int. med] dyspnoea from SIMS Lahore](https://reader038.vdocuments.net/reader038/viewer/2022110318/55d2cd21bb61eb744e8b4583/html5/thumbnails/8.jpg)
Disorders of the cardiovascular system
Pulmonary edema.Pericardium disorders.
Cardiac tamponade. Constrictive pericarditis.Pericardial effusion.
Malignant hypertension. Pulmonary embolism. Valvular heart disease.
![Page 9: [Int. med] dyspnoea from SIMS Lahore](https://reader038.vdocuments.net/reader038/viewer/2022110318/55d2cd21bb61eb744e8b4583/html5/thumbnails/9.jpg)
Disorders of the cardiovascular system
Aortic dissection. Cardiomyopathy.Congenital heart disease. Heart failure. Ischemic heart disease.
![Page 10: [Int. med] dyspnoea from SIMS Lahore](https://reader038.vdocuments.net/reader038/viewer/2022110318/55d2cd21bb61eb744e8b4583/html5/thumbnails/10.jpg)
Disorders of the lungs
Obstructive lung diseases • Chronic obstructive pulmonary disease. Chronic Bronchitis Emphysema• Bronchial asthma. • Cystic fibrosis. • Laryngeal edema due to allergies. • Hookworm disease.
![Page 11: [Int. med] dyspnoea from SIMS Lahore](https://reader038.vdocuments.net/reader038/viewer/2022110318/55d2cd21bb61eb744e8b4583/html5/thumbnails/11.jpg)
Diseases of lung parenchyma and
pleura
Interstitial lung disease(Sarcoidosis, Pneumoconiosis, Rheumatoid lung, Scleroderma, Hisyiocytosis X, Lymphangiticcarcinomatosis, Idiopathic pulmonary fibrosis).
Fibrosing alveolitisPleural effusion/pleural fibrosis.Alveolar filling disease(alveolar proteinosis,
alveolar cell carcinoma, alveolar microlithiasis).
![Page 12: [Int. med] dyspnoea from SIMS Lahore](https://reader038.vdocuments.net/reader038/viewer/2022110318/55d2cd21bb61eb744e8b4583/html5/thumbnails/12.jpg)
Diseases of lung parenchyma and pleura
• Infections.
• Atelectasis.
• Hypersensitivity pneumonitis.
• Lung cancer.
![Page 13: [Int. med] dyspnoea from SIMS Lahore](https://reader038.vdocuments.net/reader038/viewer/2022110318/55d2cd21bb61eb744e8b4583/html5/thumbnails/13.jpg)
• Ankylosing spondylitis.• Broken ribs. • Kyphosis of the spine. • Obesity. • Pregnancy. • Pectus excavatum. • Scoliosis.
Restriction of the chest Wall
![Page 14: [Int. med] dyspnoea from SIMS Lahore](https://reader038.vdocuments.net/reader038/viewer/2022110318/55d2cd21bb61eb744e8b4583/html5/thumbnails/14.jpg)
Immobilization of the diaphragm
• Lesion of the phrenic nerve.
• Polycystic liver disease.
• Tumor in the diaphragm.
![Page 15: [Int. med] dyspnoea from SIMS Lahore](https://reader038.vdocuments.net/reader038/viewer/2022110318/55d2cd21bb61eb744e8b4583/html5/thumbnails/15.jpg)
Disorders of the blood and metabolism
Anemia. Hypothyroidism. Metabolic acidosis. Sepsis. Leukemia.
![Page 16: [Int. med] dyspnoea from SIMS Lahore](https://reader038.vdocuments.net/reader038/viewer/2022110318/55d2cd21bb61eb744e8b4583/html5/thumbnails/16.jpg)
Disorders affecting breathing nerves and
musclesAmyotrophic lateral sclerosis Guillain-Barré syndrome Multiple sclerosis Myasthenia gravis Parsonage Turner syndrome Eaton-Lambert syndrome
![Page 17: [Int. med] dyspnoea from SIMS Lahore](https://reader038.vdocuments.net/reader038/viewer/2022110318/55d2cd21bb61eb744e8b4583/html5/thumbnails/17.jpg)
Others
Psychological conditions.
Anxiety disorders and panic attacks.
Medications.
![Page 18: [Int. med] dyspnoea from SIMS Lahore](https://reader038.vdocuments.net/reader038/viewer/2022110318/55d2cd21bb61eb744e8b4583/html5/thumbnails/18.jpg)
Heart or Lung?Chronic Dyspnoea
![Page 19: [Int. med] dyspnoea from SIMS Lahore](https://reader038.vdocuments.net/reader038/viewer/2022110318/55d2cd21bb61eb744e8b4583/html5/thumbnails/19.jpg)
History(pulmonary disorders)Smoking in cardiopulmonary disease.Smoking in occupational lung diseases.Worsening dyspnoea in emphysema.Productive cough for at least three months of a
year for two consecutive year period.Wheezing in emphysema and bronchial
asthma.Repeated pulmonary infections in chronic
bronchitis.Cough,fever,pleuritic chest pain in pneumonia
![Page 20: [Int. med] dyspnoea from SIMS Lahore](https://reader038.vdocuments.net/reader038/viewer/2022110318/55d2cd21bb61eb744e8b4583/html5/thumbnails/20.jpg)
History(pulmonary disorders) Haemoptysis in bronchogenic carcinoma,
pneumonia and tuberculosis. Diaphragmatic problems cause dyspnoea that
worsen on lying down.Past history of tuberculosis.Pulmonary vascular diseases cause slowly
progressive dyspnoea.Occupational history in occupational lung
disease.Recurrent pneumothorax in COPD, and
eosinophilic pneumonia.
![Page 21: [Int. med] dyspnoea from SIMS Lahore](https://reader038.vdocuments.net/reader038/viewer/2022110318/55d2cd21bb61eb744e8b4583/html5/thumbnails/21.jpg)
History(pulmonary disorders)
Symptoms suggestive of history of connective tissue diseases, such as scleroderma, Rheumatoid arthritis, polymyositis, sarcoidosis, eosinophilic granuloma, pneumoconiosis.
Recurrent pneumothorax, diabetes insipidus in eosinophilic granuloma.
In lymphangitic carcinomatosis, symptoms caused by primary carcinoma.
• Large amount of sputum production in alveolar filling diseases.
![Page 22: [Int. med] dyspnoea from SIMS Lahore](https://reader038.vdocuments.net/reader038/viewer/2022110318/55d2cd21bb61eb744e8b4583/html5/thumbnails/22.jpg)
History(pulmonary disorders)
Drug history in pulmonary fibrosis.
Pulmonary vascular diseases; presents with slowly progressive dyspnoea.
![Page 23: [Int. med] dyspnoea from SIMS Lahore](https://reader038.vdocuments.net/reader038/viewer/2022110318/55d2cd21bb61eb744e8b4583/html5/thumbnails/23.jpg)
History (Non pulmonary diseases)
• Congestive heart failure Dyspnoea,orthopnea,paroxysmal nocturnal dyspnoea,nocturia,ankle edema.
• Psychogenic dyspnoea is the diagnosis of exclusion.• Upper airway disease patient with complaint of audible
wheezing.• Pulmonary embolism
![Page 24: [Int. med] dyspnoea from SIMS Lahore](https://reader038.vdocuments.net/reader038/viewer/2022110318/55d2cd21bb61eb744e8b4583/html5/thumbnails/24.jpg)
History (Non pulmonary diseases)Non cardiogenic pulmonary edemaH/o hemorrhagic or septic shock.H/O acute pancreatitis.Multiple trauma.Near drowning.Pneumonia.High altitude pulmonary edema.
![Page 25: [Int. med] dyspnoea from SIMS Lahore](https://reader038.vdocuments.net/reader038/viewer/2022110318/55d2cd21bb61eb744e8b4583/html5/thumbnails/25.jpg)
Hyperventilation SyndromeResponse to stress, anxiety.Patient exhales CO2 faster than metabolism
produces it.Blood vessels in brain constrict.Anxiety, dizziness, lightheadedness.Seizures, unconsciousness.Chest pains, dyspnea.Numbness, tingling of fingers, toes, area
around mouth, and nose. Carpopedal spasms of hands, feet.
![Page 26: [Int. med] dyspnoea from SIMS Lahore](https://reader038.vdocuments.net/reader038/viewer/2022110318/55d2cd21bb61eb744e8b4583/html5/thumbnails/26.jpg)
Physical examination
![Page 27: [Int. med] dyspnoea from SIMS Lahore](https://reader038.vdocuments.net/reader038/viewer/2022110318/55d2cd21bb61eb744e8b4583/html5/thumbnails/27.jpg)
Cardiac causes Pulmonary edemaLateral or downward displacement of apex
beat.Third heart sound.Gallop rhythm.MurmursFine crepitations at lung bases.Wheezes.Periphral edema,Hepatomegaly,distended neck
veins are the signs of right sided heart failure.
![Page 28: [Int. med] dyspnoea from SIMS Lahore](https://reader038.vdocuments.net/reader038/viewer/2022110318/55d2cd21bb61eb744e8b4583/html5/thumbnails/28.jpg)
Non cardiogenic Pulmonary edema;Shock.Patechial haemorrages.Wheeze.Crepitations.
![Page 29: [Int. med] dyspnoea from SIMS Lahore](https://reader038.vdocuments.net/reader038/viewer/2022110318/55d2cd21bb61eb744e8b4583/html5/thumbnails/29.jpg)
Examination(pulmonary disorders)
Emphysema Anteroposterior diameter of chest is
increased, hypertrophy of accessory muscles of respiration, hyperresonant percussion note, decreased breath sounds with prolonged expiration.
![Page 30: [Int. med] dyspnoea from SIMS Lahore](https://reader038.vdocuments.net/reader038/viewer/2022110318/55d2cd21bb61eb744e8b4583/html5/thumbnails/30.jpg)
Examination(pulmonary disorders)
Chronic bronchitis• Diagnosed by the history, patient may have
the findings of airway obstruction.• Cyanotic, plethoric or have signs of
corpulmonale in severe disease.
![Page 31: [Int. med] dyspnoea from SIMS Lahore](https://reader038.vdocuments.net/reader038/viewer/2022110318/55d2cd21bb61eb744e8b4583/html5/thumbnails/31.jpg)
Examination(pulmonary disorders)
Chronic Bronchial asthma• Wheezing.
• Signs of hyperinflation of lungs.
![Page 32: [Int. med] dyspnoea from SIMS Lahore](https://reader038.vdocuments.net/reader038/viewer/2022110318/55d2cd21bb61eb744e8b4583/html5/thumbnails/32.jpg)
Examination(pulmonary disorders)
Restrictive lung disease• Interstitial lung disease; clubbing, dry
inspiratory bibasilar crepitations.• Signs of associated systemic diseases like
arthritis, skin rash, lymphadenopathy, splenomegaly.
• Evidence of primary carcinoma in lymphangitic carcinomatosis.
![Page 33: [Int. med] dyspnoea from SIMS Lahore](https://reader038.vdocuments.net/reader038/viewer/2022110318/55d2cd21bb61eb744e8b4583/html5/thumbnails/33.jpg)
Examination(pulmonary disorders)
Thoracic abnormalities are evident on physical examination.
Pleural fibrosis; diminished expansion of chest wall, dull percussion note decreased fremitus and decreased breath sounds.
Rales in alveolar filling defects.Pulmonary hypertension; right ventricular
lift and loud P2.and periphral edema.
![Page 34: [Int. med] dyspnoea from SIMS Lahore](https://reader038.vdocuments.net/reader038/viewer/2022110318/55d2cd21bb61eb744e8b4583/html5/thumbnails/34.jpg)
Examination(pulmonary disorders) Upper Airway( IDL)
• Foreign Body Obstruction• Pharyngeal Edema• Croup• Epiglottitis Suspect in any child with sudden onset of
dyspnea. Suspect in any adult who develops dyspnea
or loses consciousness while eating.
![Page 35: [Int. med] dyspnoea from SIMS Lahore](https://reader038.vdocuments.net/reader038/viewer/2022110318/55d2cd21bb61eb744e8b4583/html5/thumbnails/35.jpg)
Examination (Non pulmonary diseases Anemia pallor. Upper airway disease Wheezing, stridor and a tracheostomy
scar. Obesity with excess adiposity.
![Page 36: [Int. med] dyspnoea from SIMS Lahore](https://reader038.vdocuments.net/reader038/viewer/2022110318/55d2cd21bb61eb744e8b4583/html5/thumbnails/36.jpg)
Investigations
![Page 37: [Int. med] dyspnoea from SIMS Lahore](https://reader038.vdocuments.net/reader038/viewer/2022110318/55d2cd21bb61eb744e8b4583/html5/thumbnails/37.jpg)
Chest X-rayPneumoniaLobar consolidation with air
bronchograms.Pleural effusions.Diffuse and non lobar consolidation in viral
and mycoplasma infection.
![Page 38: [Int. med] dyspnoea from SIMS Lahore](https://reader038.vdocuments.net/reader038/viewer/2022110318/55d2cd21bb61eb744e8b4583/html5/thumbnails/38.jpg)
Chest X-ray Chronic Obstructive airway Disease• Emphysema;Bullous changes,evidence of
hyperinflation of lungs and attenuation of pulmonary vasculature.
• Chronic bronchitis;evidence of corpulmonle(RVH associated with pulmonary hypertension).
![Page 39: [Int. med] dyspnoea from SIMS Lahore](https://reader038.vdocuments.net/reader038/viewer/2022110318/55d2cd21bb61eb744e8b4583/html5/thumbnails/39.jpg)
Chest X-ray Chronic bronchial asthma;
• Hyperinflation,diffuse fibrosis or chronic segmental fibrosis.
![Page 40: [Int. med] dyspnoea from SIMS Lahore](https://reader038.vdocuments.net/reader038/viewer/2022110318/55d2cd21bb61eb744e8b4583/html5/thumbnails/40.jpg)
Chest X-rayRestrictive lung disease;• In interstitial lung disease,
linear ,fibronodular, or fibroreticular infiltrates.
• Lytic lesions of ribs or pneumothorax in histiocytosis X.
• Kerly’s lines,pleural effusions, and mediastinal lymphnodes in lymphangitic carcinomatosis.
• A lung mass may be demonstrable.
![Page 41: [Int. med] dyspnoea from SIMS Lahore](https://reader038.vdocuments.net/reader038/viewer/2022110318/55d2cd21bb61eb744e8b4583/html5/thumbnails/41.jpg)
Chest X-rayHypomotility and dilatation of esophagus
owing to connective tissue disease may be manifested as mediastinal airfluid levels.
Silicosis is upper lobe disease with multiple interstitial nodules.
Cavitary shadows due to superimposed mycobacterial infection.
Asbestosis predominantly involve lower lobe in a linear pattern with pleural thickening or calcified plaques on pleura.
![Page 42: [Int. med] dyspnoea from SIMS Lahore](https://reader038.vdocuments.net/reader038/viewer/2022110318/55d2cd21bb61eb744e8b4583/html5/thumbnails/42.jpg)
Chest X-ray• Kyphosis and scoliosis are obvious skeletal
deformities.• Air bronchograms in alveolar filling
diseases.• Pulmonary hypertension showed enlarged
pulmonary arteries with or with out air bronchograms.
![Page 43: [Int. med] dyspnoea from SIMS Lahore](https://reader038.vdocuments.net/reader038/viewer/2022110318/55d2cd21bb61eb744e8b4583/html5/thumbnails/43.jpg)
Chest X-rayCongestive heart failure; upper lobe
diversions hilar congestion, kerley B lines.Anemia ;chest X-ray is normal,at times
cardiomegaly is there.Upper airway disease it is usually normal.Obese patients have usually normal chest
x-ray.
![Page 44: [Int. med] dyspnoea from SIMS Lahore](https://reader038.vdocuments.net/reader038/viewer/2022110318/55d2cd21bb61eb744e8b4583/html5/thumbnails/44.jpg)
Laboratory dataComplete blood count.Urine analysis.Blood chemistries.Sputum examination.Electrocardiogram.Blood gases.Serum protein electrophoresis to look for
alpha-1 globulin level.Alpha-1 antrypsin levels.
![Page 45: [Int. med] dyspnoea from SIMS Lahore](https://reader038.vdocuments.net/reader038/viewer/2022110318/55d2cd21bb61eb744e8b4583/html5/thumbnails/45.jpg)
Pulmonary function testsFEV-1.
FEV-1/FVC.
![Page 46: [Int. med] dyspnoea from SIMS Lahore](https://reader038.vdocuments.net/reader038/viewer/2022110318/55d2cd21bb61eb744e8b4583/html5/thumbnails/46.jpg)
CT scan of the chest
![Page 47: [Int. med] dyspnoea from SIMS Lahore](https://reader038.vdocuments.net/reader038/viewer/2022110318/55d2cd21bb61eb744e8b4583/html5/thumbnails/47.jpg)
Lung biopsy