The patient is a 67-year-old male former smoker presenting with shortness of breath on exertion. Physical examination finds reduced breath sounds and wheezing. Tests show reduced lung function and oxygen levels. The differential diagnosis includes cardiac and pulmonary causes like COPD. Dyspnea is the medical term for shortness of breath and can result from various lung and heart conditions. Treatment focuses on the underlying cause, like using bronchodilators for COPD.

1. Shortness of Breath during
Exertion
Fatima AlAwadh

2. Objectives
Summarize the case ( Signs & Symptoms & Findings).
Define Dyspnea.
Demonstrate the Differential Diagnosis.
Display the Anatomy of the Respiratory Tract.
Recognize the Volumes of the Lung.
Clarify the Physiology of Breathing.
Understand the Pathophysiology of Dyspnea.
Mention the Diagnostic Investigations.
Enumerate First Aids & Treatments.

3. Case
Smoke two packs of
67-year-old man.
cigarettes a day.
Stopped smoking six Retired coffee
years ago. salesman.
Married. No pets.
Drinks little alcohol. No other illnesses.

4. Case Signs & Symptoms
No shivers, sore
throat, vomiting, diarr
Looks pale, feels as his hea, and not sick.
temperature is raised.
Productive cough
with green sputum.
Shortness of
breath due to Trouble breathing
effort. while sitting still.

5. Case Findings on Physical
Examination
Trachea is
Thin with
Moderate SOB positioned in
broad chest
the midline
Thorax moves Reduced
Breathing rate
up & down breath sound
is 32 per min
symmetrically across lung
Wheezing on
expiration

6. Case Findings on Physical
Examination
Extended BP 132/78 Heart rate 94
expiration mmHg per min
Arterial
Decreased Increase
oxygen
FVC & FEV1 TLC, FRC & RV
saturation 91%

7. Dyspnea
Dyspnea, the sensation of breathlessness or
inadequate breathing, is the most common
complaint of patients with cardiopulmonary
diseases.
Dyspnea - common complaint “shortness of
breath”.
Defined as uncomfortable breathing.
Dyspnea on exertion is excessive or abnormal
shortness of breath on exertion.

8. Differential Diagnosis
Four general categories:
Cardiac Pulmonary
Mixed non-cardiac
cardiac or non-
pulmonary pulmonary

9. Pulmonary Etiology
Restrictive
COPD Asthma Lung
Disorders
Hereditary
Pneumo-
Lung Pneumonia
thorax
Disorders

10. Cardiac Etiology
Recent or past
Congestive
Coronary Artery history of
Heart Failure Cardiomyopathy
Disease (CAD) Myocardial
(CHF)
Infarction (MI)
Left
Valvular
ventricular Pericarditis Arrhythmias
dysfunction
hypertrophy

11. Mixed Cardiac/Pulmonary Etiology
COPD with Chronic
pulmonary Pleural
HTN and/or
Deconditioning pulmonary
effusion
cor pulmonale emboli

12. Noncardiac or Nonpulmonary
Etiology
Metabolic
conditions Pain Trauma
(e.g. acidosis)
Functional
Neuromuscular disorders Chemical exposure
(anxiety, panic, hyperventilation)

13. Anatomy Respiratory Tract

14. Pulmonary Volumes & Capacities

15. Pulmonary Volumes
The tidal volume
•the volume of air inspired or expired with each normal breath (about 500 ml).
The inspiratory reserve volume
•the extra volume of air that can be inspired over and above the tidal volume with full
force (about 3000 ml).
The expiratory reserve volume
•the maximum extra volume of air that can be expired by forceful expiration after end
of tidal expiration (about 1100 ml).
The residual volume
•the volume of air remaining in the lungs after the most forceful expiration (about 1200
ml).

16. Pulmonary Capacities
The inspiratory capacity
• The amount of air a person can breathe in (about 3500 ml).
The functional residual capacity
• The amount of air remains in the lungs after normal expiration (about
2300 ml).
The vital capacity
• The maximum amount of air that can be expelled after first filling the
lungs to maximum and expiring to maximum (about 4600 ml).
The total lung capacity
• The maximum volume to which the lungs can be expanded with the
greatest possible effort (about 5800 ml).

17. Physiology of Breathing

18. Pathophysiology
The pathophysiology is poorly
understood.
There are no specialized receptors for
dyspnea.
Recent MRI studies have identified a
few specific areas in the midbrain that
may mediate perception of dyspnea.

19. Pathophysiology
Dyspnea likely results from the complex interaction between:
chemoreceptor mechanical breathing perception of
stimulation abnormalities those two by the
(Afferent) (Efferent) CNS

20. Pathophysiology
Dyspnea results when a
"mismatch" occurs in CNS
between afferent & efferent
signaling.
As the brain receives afferent
ventilation information, it is
able to compare it to the
current level of respiration by
the efferent signals.
If the level of respiration is
inappropriate for the body's
status then dyspnea might
occur.

21. Diagnosis
Chest radiographs
Electrocardiograph
Screening
spirometry

22. Diagnosis
In cases where test results
inconclusive
complete PFTs
ABGs
Standard exercise treadmill testing or
complete cardiopulmonary exercise testing
Consultation with
pulmonologist/cardiologist may be useful

23. First Aid
Check the
Loosen any tight
call local emergency. airway, breathing, and If necessary, begin CPR.
clothing.
pulse.
Bandage the sucking
Help the person use open wounds (esp with
monitor breathing and wound with plastic
any prescribed air bubbles) in neck or
pulse. wrap sealing it except
medication chest must be closed
for one corner.

24. First Aid
DO NOT
Do NOT give the person food or drink.
Do NOT move the person if there has been a chest or
airway injury, unless it is absolutely necessary.
Do NOT place a pillow under the person's head. This
can close the airway.
Do NOT wait to see if the person's condition improves
before getting medical help. Get help immediately.

25. Treatment
The primary treatment is directed
at its underlying cause.
Examples
if fluid is collecting in the lung, the fluid
may need to be drained to lessen the
dyspnea.
Chemotherapy or radiation therapy may
shrink a tumor to lessen the dyspnea.
If dyspnea is being caused by an
infection, antibiotics may be needed.

26. Pharmacological Treatment
Bronchodilators
open a patient's airways and decrease their dyspnea.
Steroids
help reduce swelling in the lungs that may be causing
the shortness of breath.
Anti-anxiety drugs
can help break the cycle of panic that can lead to
more breathing difficulties.
Pain medications
can make breathing easier.

27. References
http://www.joshcorwin.com/pa/PAC18%20-
%20Emergency%20Medicine/Test%201/DYSPNEA.PPT
http://nursingcrib.com/case-study/asthma-case-study/
Guyton and Hall Textbook of Medical Physiology
http://sciencscarter08-
28.wikispaces.com/Respiratory+System+101
Merck Manual of Diagnosis & Therapy
http://en.wikipedia.org/wiki/Dyspnea#Treatment
http://www.umm.edu/ency/article/000007trt.htm
http://www.valleyhealthlink.com/Taxonomy/RelatedDocuments.
aspx?id=0&sid=0&ContentTypeId=34&ContentID=21274-1

28. Thanks