dyspnoea easy understanding

1. DYSPNEA
DR. SIDDHARTH – MED PG

2. DEFINITION
 Dyspnea is defined as difficult or labored
breathing or the unpleasant awareness of
ones breathing.
 The American Thoracic Society defines
dyspnea as a “subjective experience of
breathing discomfort that consists of
qualitatively distinct sensations that vary in
intensity.

3. MECHANISM
 Respiratory sensations are the consequence
of interactions between the efferent i.e. the
motor output from the brain to the ventilatory
muscles and the afferent i.e. sensory input
from receptors throughout the body (feedback)
which are integrated in the brain.

9. ASSOCIATION OF QUALITATIVE
DESCRIPTORS & MECHANISMS

10. ACUTE DYSPNEA
 Acute pulmonary edema
 Pneumothorax
 Pulmonary embolism
 Pneumonia
 Airway obstruction

11. CHRONIC DYSPNEA
 Heart failure
 Pulmonary disease
 Anxiety
 Obesity
 Poor physical fitness
 Pleural effusion
 Asthma

12. RESPIRATORY CAUSES OF
DYSPNEA
 Diseases of the airway - COPD & ASTHMA
 Diseases of the chest wall – Kyphoscoliosis,
weakness of vent muscles such as
myasthenia gravis, GBS.
 Diseases of the lung parenchyma –
Autoimmune disorders, ILD, Infections,
Occupational exposure

13. CARDIOVASCULAR CAUSES
 Diseases of the left heart – Diseases of
myocardium resulting from CAD, Non ischemic
cardiomyopathy.
 Diseases of the pulmonary vasculature -
Pulmonary thromboembolism, Pulmonary
hypertension, Pulmonary vasculitis.
 Diseases of the pericardium – Constrictive
pericarditis, cardiac tamponade.

14. OTHER CAUSES
 Mild to moderate anemia
 Obesity due to:
a. Decreased compliance of the chest wall.
b. Cardiovascular deconditioning (poor
fitness)
 Dyspnea that is medically unexplained has
been associated with increased sensitivity to
the unpleasantness of acute hypercapnia.

15. DYSPNEA SUGGESTING
PULMONARY CAUSE
 Cough with expectoration
 Wheezing
 No relation to exertion
 Fever
 Pleuritic chest pain
 Loss of wt.
 Progressive over many years
 Prompt response to Oxygen and
bronchodilators
 Seasonal variation

16. DYSPNEA SUGGESTIVE OF
CARDIAC CAUSE
 PND and orthopnea
 Associated with symptoms of heart disease
 Expectorant pink frothy sputum
 Rapid progression
 Response to diuretics and digoxin

19. PND
 PND is the occurrence of dyspnea during
sleep
 Typically, a patient is woken up few hours into
sleep with transient acute pulmonary edema.
 In contrast to orthopnea it can last up to half
an hour or so.
 PND is relieved by assuming upright position

20. MECHANISM
 Absorption of edema fluid with increase in Rt
ventricular output causing over filling the lungs
 Diminished sympathetic drive of sleep,
decreasing LV contractility
 Nocturnal arrhythmia
 Sleep apnea

21. ORTHOPNEA
 It refers to dyspnea on supine position
 It results from increase in hydrostatic pressure
in lung that occurs in assumption of supine
position.
 Sitting up leads to rapid relief of symptom.

22.  It is related to increase in venous return to the
heart in supine position.
 Increase in venous return which can not be
handled by failing left ventricle.
 It is a sign of LV dysfunction

23.  It is associated with cough which is called as
nocturnal cough.
 The transient rise in left ventricular pressure
results in transient lung stiffness and
consequent cough.
 The severity can be graded by the number of
pillow used at night, ex. Three pillow
orthopnea

24. CAUSES
 Left heart failure
 COPD
 Constrictive pericarditis
 Severe ascites
 B/L Diaphragmatic paralysis

25. MS
 Dyspnea is the initial presenting symptom of
MS
 It occurs from beginning of disease due to
Pulmonary venous hypertension
 Unlike aortic stenosis patient with MS with
onset of dyspnea live beyond 5 years.
 It has prognostic importance in MS
 NYHA functional class I has 10 years survival
of 85% and class III of 20%

26. AS
 Angina, syncope and dyspnea are the three
cardinal symptom of AS
 Dyspnea is late in onset cause of PVH occurring
after onset of LV dysfunction
 After onset of dyspnea the avg survival is 1.5
years
 Causes of dyspnea in mild AS:
a. Associated mitral valve disease
b. Hypertrophic Cardiomyopathy
c. CAD
d. Unrelated pulmonary disorder

27. MR
 Palpitation is first symptom in MR and dyspnea
follows
 Unlike MS, dyspnea occurs only after onset LV
failure
Severe MR in non compliant LA
Associated MS
 Rapid progression of dyspnea in MR:
Infective endocarditis
Recurrence of rheumatic activity
Chordal rupture
onset of AF
CAD

28. AR
 Dyspnea occurs late in course of AR with
onset of LV failure
 Early onset of dyspnea indicate associated
mitral valve disease or acute AR
 It is late to appear and progresses slowly
 Dyspnea class II,III,IV should be consider as
indication of surgery

30. CYANOSIS
 It refers to blush discoloration of skin and
mucous membrane resulting from an
increased quantity of reduced hemoglobin
(deoxy Hb) or of hemoglobin derivatives. ( eg:
Methemoglobin/sulfhemoglobin )

32. TYPES

33. PERIPHERAL CYANOSIS
 Peripheral cyanosis occurs due to slowing of
blood flow. Arterial blood is normally saturated.
 It results from vasoconstriction and diminished
peripheral blood flow such as
1. Cold exposure
2. Shock
3. Congestive heart failure
4. Arterial obstruction- embolus/PVD
5. Venous obstruction-
Thrombophlebitis/DVT

34. CENTRAL CYANOSIS
 Its due to reduced SaO2 in blood or due to an
abnormal Hb derivative.
 Causes:
1. Decreased atm Hg- high altitude
2. Impaired pulmonary function
a. Alveolar hypoventilation- Ext pneumonia
pulmonary edema
Emphysema
b. Ventilation – perfusion mismatch
c. Impaired oxygen diffusion

35.  3. Anatomic shunts
a. Cyanotic congenital heart disease
b. pulmonary atreriovenous fistula
c. Multiple small intrapulmonary shunts
4. Hb abnormalities:
a. Methemoglobinemia
b. Sulfhemoglobinemia
c. Carboxyhemoglobinemia

37.  THANK U