This document discusses cardiopulmonary disease and provides information on: 1. The causes of shortness of breath including pulmonary and cardiac issues as well as systemic illnesses. 2. The indications and uses of chest x-rays which can help diagnose lung, heart, skeletal and soft tissue problems. 3. The components of respiratory examination including inspection, palpation, percussion, and auscultation and what each technique evaluates. 4. Common breath sounds like vesicular, whistling, and crepitus and their characteristics.

1. Case 4.2
Fatima AlAwadh
Fatima AlMohammed Saleh

2. Objectives
 List the causes of shortness of breath.
 State chest x-ray indications (uses).
 Describe breathing pattern assessment.
 Define vesicular & whistling breathing sounds.
 Define Crepitus & mention its causes.
 Enumerate the indications of Visible jugular veins,
nitroglycerin, and continuous murmur of the apex.
 Discriminate the differential diagnosis.
 Explain the papillary muscle rupture.
 Define and relate cardiac asthma and COPD with our
case.

3. Introduction
Cardiopulmonary disease is disease which
involves both the heart and lungs.
It may be known as heart-lung disease.
It can take a number of forms.
Left untreated, cardiopulmonary disease can
be deadly.

4. Shortness of Breath
 Defined as uncomfortable breathing.
 Etiology of SOB :
Pulmonary
• pneumonia, tuberculosis or chronic Asthma, chronic
obstructive lung disease (COPD), emphysema,
pulmonary embolism, pneumothorax.
Cardiac
• Heart Failure.
Systemic Illness Problems
• Anemia, and Increased metabolic states.

5. Indications of Chest X-Ray
• Pathology of the skeletal system as well
Diagnostic
as for some soft tissue diseases.
• To asses progression of a condition or
effectiveness of treatment.
• To check the position of implanted
pacemaker wires and other internal
Progressive devices
• To check status of lungs and chest cavity
after surgery.

6. Diagnostic Chest X-ray
Cardiovascular
Rib Fracture Lung Problems
problems
• Lung cancer. • Cardiomegaly.
• COPD. • Congenital heart
• Pleuritis. diseases.
• Heart failure.
• Pneumonia.
• Pericardial effusion.
• Pneumothorax. • Valvular heart
• Pulmonary diseases.
edema • Calcification of the
heart structures.

7. Respiratory Examination
RESPIRATORY ASSESSMENT CONSISTS
OF FOUR COMPONENTS
1. Inspection
2. Palpation
3. Percussion
4. Auscultation

8. Inspection
Inspection involves using your eyes and ears to assess
a variety of things regarding the patient.
With the patient sitting, examine the patient's anterior
and posterior chest for the following
 General Appearance; Color, Ability to speak, &
Respiratory effort.
 Skin Color; especially Around mouth/lips & Nail
beds.
 Chest Wall Abnormalities; as Scoliosis & kyphosis.
 Noisy Breathing.
 Pursed Lip Breathing.
 Coughing.
 Respiratory Rate & Pattern.

9. Palpation
An assessment technique in which the
examiner uses the surface of the
fingers and hands to feel for
abnormalities.
Assessment data that canbe obtained
through palpation includes:
 identifying chest movement
symmetry.
 chest skeletal abnormalities.
 Tenderness.
 skin temperature changes.
 Swelling & masses.

10. Percussion
Types of percussion notes:
 Flat (over bone)
 Dull (muscle & soft tissue)
 Resonant (normal lung)
 Hyper-resonant
(Emphysema)
 Tympanic (free air)

11. Auscultation
During auscultation
Patient should be upright
taking deep breaths through
the mouth.
 Eliminate outside noise if
Possible.

12. Auscultation

13. Vesicular breathing sound
Vesicular sounds are soft, or
rustling sounds normally heard
throughout most of the lung fields.
Vesicular sounds are normally
heard throughout inspiration,
continue without pause through
expiration.
Medium pitch & loudness.
Inspiration louder.

14. Whistling
Abnormal, high pitched
breath sounds.
Heard in the airways.
Caused by air being
forced through narrowed
passageways by
secretions or another
mechanical or functional
obstruction.

15. Crepitus
Is crackling chest sound heard in
pneumonia and other lung
diseases.
Caused by fluid in the small
airways.
The popping sounds produced
are created when air is forced
through narrowed respiratory
passages by fluid.

16. Crepitus Etiology
 Crackles are often associated with
inflammation or infection of the small
bronchi, bronchioles, and alveoli.
 Crackles may indicate pulmonary edema or
fluid in the alveoli due to heart failure or adult
respiratory distress syndrome (ARDS).

17. Differential Diagnosis
Left sided
Mitral valve
heart regurgitation
failure
Papillary
Pulmonary
muscle
Edema
dysfunction

18. Papillary muscle
Papillary muscles are small
finger like structures that arise
from the wall of the ventricles
and are attached to the
leaflets of atrioventricular
valves.

19. Papillary muscle rupture
As a result blood
The entire The mitral valve
will flow
muscle may will no longer
backwards into
function
become the lung, and they
effectively
detached from because of this
will fill with fluid
the ventricular causing acute
sudden
wall. pulmonary
incompetence.
edema.

20. Chronic Obstructive Pulmonary Disease
 COPD is a partially reversible airflow limitation
caused by an inflammatory response to
inhaled toxins, after cigarette smoke.
 Symptoms are productive cough and
dyspnea that develop over years.
 Common signs include decreased breath
sounds, prolonged expiratory phase, and
wheezing.
 Diagnosis is based on history, physical
examination, chest x-ray, and pulmonary
function tests.

21. Cardiac Asthma
 A medical symptom, of
wheezing, coughing or shortness
of breath.
 It is known as cardiac asthma
because the symptoms may
mimic asthma.
 As a result of heart failure, fluid
can build up in the lungs
(pulmonary edema) and in and
around airways.

22. Nitroglycerin
The prevention or relief of
angina pectoris.
 A thick, pale yellow
liquid.
Treating pulmonary
 Used as a vasodilator in hypertension,
medicine.
 The drug should not be Helping to treat congestive
heart failure following
used continuously, acute myocardial infarction
because tolerance
develops within 24 to 48 And treating hypertensive
emergencies during
hrs. cardiovascular surgery.
 It is prescribed for :