Dyspnoea
Introduction[edit | edit source]
Dyspnoea/ dyspnea also known as shortness of breath or breathlessness, is a subjective awareness of the sensation of uncomfortable breathing.
[1].it is a sensation of running out of the air and of not being able to breathe fast enough or deeply enough[2] Dyspnoea is a subjective sensation which probably develops as a result of integration of signals from the central nervous system and some peripheral receptors. Known dyspnoegenic stimuli include the sensation of an increased effort of the respiratory muscles, information from chemoreceptors on the inadequacy of ventilation, from pulmonary receptors on the compression of the airways and disharmony between information on the tension of the respiratory muscles and the corresponding shortening of the muscle.[3]Dyspnea represents one of the most frequent cardinal symptoms in general practice and interdisciplinary emergency care across all sectors[4]
Epidemiology[edit | edit source]
The epidemiology of dyspnea is highly variable depending on etiology.[2]
Mechanism of Injury / Pathological Process[edit | edit source]
Clinical Presentation[edit | edit source]
add text here relating to the clinical presentation of the condition
Diagnostic Procedures[edit | edit source]
physical exam should begin with a rapid assessment of the ABCs (airway, breathing, and circulation). Once a patient is determined to be stable, a full physical exam can be done. To determine the severity of dyspnea, observe respiratory effort, use of accessory muscles, mental status, and speaking ability. Distention of the neck veins implies cor pulmonale caused by severe COPD, congestive heart failure, or cardiac tamponade. Thyromegaly may indicate hyperthyroidism or hypothyroidism. The tracheal deviation may indicate possible anatomic abnormality or pneumothorax. Auscultate for stridor in the upper airways indicates obstructed airway. Palpation of the chest can determine the presence of subcutaneous emphysema or crepitus. Percussion of the lung lobes for dullness can determine the presence or absence of consolidation and effusion. Hyperresonance on percussion is a worrisome finding that indicates possible pneumothorax or severe bullous emphysema. Lung auscultation may reveal absent breath sounds indicating the presence of pneumothorax or region occupying mass such as pleural effusion or malignancy. The presence of wheezing is highly consistent with the diagnosis of an obstructive lung disease such as asthma or COPD. However, wheezing may be associated with pulmonary edema or pulmonary embolism. Pulmonary edema and pneumonia may present with rales on auscultation. Auscultation of the heart may reveal the presence of dysrhythmia, cardiac murmurs, or aberrant heart gallops. An S3 gallop indicates cardiac overfilling seen in left ventricular systolic dysfunction and congestive heart failure. An S4 gallop suggests left ventricular dysmotility and dysfunction. A loud P2 indicates possible pulmonary hypertension. Murmurs may indicate valvular dysfunction. Diminished heart sounds may indicate cardiac tamponade. Pericarditis may present with a rubbing cardiac sound on auscultation. On abdominal examination, hepatomegaly, ascites, positive hepatojugular reflux may indicate the diagnosis of congestive heart failure. Lower extremities edema is associated with congestive heart failure, and extreme swelling of the extremities suggest possible deep venous thrombosis that can lead to a pulmonary embolism. Digits clubbing is present in some forms of lung malignancy or severe chronic hypoxia. Cyanosis of the extremities indicates hypoxia.[5]
Outcome Measures[edit | edit source]
In itself, dyspnea is harmless. However, it is a symptom, not an illness. Therefore, the outcomes is highly variable depending on the exact etiology and patient demographics[5].
add links to outcome measures here (see Outcome Measures Database)
Management / Interventions[edit | edit source]
Dyspnea can be either acute or chronic with acute occurring over hours to days and chronic occurring for more than 4 to 8 weeks.[2]
Differential Diagnosis[edit | edit source]
Dyspnea is a symptom of the disease, rather than a disease itself. As such, its etiology can be designated as arising from four primary categories: respiratory, cardiac, neuromuscular, psychogenic, systemic illness, or a combination of these.
Respiratory causes may include asthma, acute exacerbation of or chronic congestive obstructive pulmonary disorder (COPD), pneumonia, pulmonary Embolism, lung malignancy, pneumothorax, or aspiration.
Cardiovascular causes may include congestive heart failure, pulmonary edema, acute coronary syndrome, pericardial tamponade, valvular heart defect, pulmonary hypertension, cardiac arrhythmia, or intracardiac shunting.
Neuromuscular causes may include chest trauma with fracture or flail chest, massive obesity, kyphoscoliosis, central nervous system (CNS) or spinal cord dysfunction, phrenic nerve paralysis, myopathy, and neuropathy.
Psychogenic causes may include hyperventilation syndrome, psychogenic dyspnea, vocal cord dysfunction syndrome, and foreign body aspiration.
Other systemic illnesses may include anemia, acute renal failure, metabolic acidosis, thyrotoxicosis, cirrhosis of the liver, anaphylaxis, sepsis, angioedema, and epiglottitis[2]
Resources[edit | edit source]
add appropriate resources here
References[edit | edit source]
- ↑ Coccia CB, Palkowski GH, Schweitzer B, Motsohi T, Ntusi NA. Dyspnoea: Pathophysiology and a clinical approach. SAMJ: South African Medical Journal. 2016 Jan;106(1):32-6.
- ↑ 2.0 2.1 2.2 2.3 Sharma S, Hashmi MF, Badireddy M. Dyspnea on Exertion (DOE). InStatPearls [Internet] 2020 May 23. StatPearls Publishing.
- ↑ Smejkal V. Dyspnea remains a complicated medical (clinical) problem. Casopis Lekaru Ceskych. 2000 Jan 1;139(1):9-12.
- ↑ Hauswaldt J, Blaschke S. Dyspnoe. Der Internist. 2017 Sep 1;58(9):925-36.[1]
- ↑ 5.0 5.1 Sharma S, Hashmi MF, Badireddy M. Dyspnea on Exertion (DOE). InStatPearls [Internet] 2020 May 23. StatPearls Publishing.
