medical

1. Abdullah Bin Mohd Subri
Credited to : Syahirah 
Coronavirus Issue

2. TYPES OF DYSPNEA
EXERTIONAL DYSPNEA
ORTHOPNEA
PAROXYSMAL NOCTURNAL DYSPNEA
PLATYPNEA
TREPOPNEA

3. EXERTIONAL DYSPNEA
Shortness of breath when exercise and improves with rest
GRADING FOR DYSPNEA

4. ORTHOPNEA
• Shortness of breath when lying down (recumbent position)
• Relieved by sitting up or elevation of head with pillows
• Occurs within 1-2 minutes after lying down
• Examples : Congestive cardiac failure (CCF), asthma, bilateral paralysis of diaphragm
MECHANISM OF ORTHOPNEA
Lying down / Horizontal position
↓
Redistribution of blood volume from lower extremities to the
heart ( increased venous return )
↓
In left ventricular failure, not able to pump out extra volume of
blood
↓
Backflow of blood to the lung
↓
Pulmonary congestion
↓
Dyspnea
Diaphragm paralysis
or lung collapse
↓
Elevated diaphragm
↓
↓ vital capacity

5. PAROXYSMAL NOCTURNAL DYSPNEA
• Shortness of breath which occur at night and makes the patient wake up from sleep
• Occur usually 1-2 hours after sleep
• Shorter duration of dyspnea (10-30 min)
• Example : Left sided failure / Cardiac asthma
MECHANISM OF PND
Due to gradual reabsorption of lower extremity
interstitial edema into the circulation
↓
↑ intravascular blood volume
↓
↑ venous return to the heart and lung
↓
Pulmonary congestion
↓
Dyspnea

6. PLATYPNEA
• Shortness of breath occurs when in upright position (sitting/standing)
• Relieved by supine position
• Examples : Pulmonary AV malformation, hepatopulmonary syndrome
MECHANISM OF PLATYPNEA
Upright (Sitting position)
↓
Gravitational force causes more blood goes to lower
zone of lung
↓
↑ perfusion and ↓ ventilation
↓
V/Q mismatch
↓
Dyspnea

7. TREPOPNEA
Shortness of breath when lying on one side (lateral recumbent position)
Relieved by lying on opposite side
Causes : Unilateral lung disease, CHF
MECHANISM OF TREPOPNEA
Patient lies on affected side
↓
Gravitational force causes more blood goes to lower zone of
lung
↓
↑ perfusion and ↓ ventilation in diseased organ
↓
V/Q mismatch ( increased shunting )
↓
hypoxemia
↓
Worsen dyspnea

8. CLASSIFICATION OF DYSPNEA

9. In Ralston, S. H., In Penman, I. D., In Strachan, M. W. J., & In Hobson, R. P. (2018). Davidson's
principles and practice of medicine.
P. J. Mehta (2018). Common Medical Symptoms.
Mukerji V. Dyspnea, Orthopnea, and Paroxysmal Nocturnal Dyspnea. In: Walker HK, Hall WD,
Hurst JW, editors. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd
edition. Boston: Butterworths; 1990. Chapter 11. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK213/
REFERENCES