A chest radiographic image taken 3 years earlier, which the patient brought with him, showed an enlarged cardiac silhouette, suggesting that a chronic process was causing his heart failure. HIV serology was positive. Echocardiogram showed severely dilated ventricles with moderately depressed left and right ventricular function and bilateral dilated atria. There was no evidence of pericardial effusion or pulmonary hypertension by estimation.
Dyspnea, is defined by the American Thoracic Society as a subjective experience of breathing discomfort. This experience comes from interactions among various physiological, psychological, and environmental factors.
Dsypnea is a symptom and it should not be confused with the increased work of breathing, which is a physical sign. In order to be reported as a symptom, a sensation should be perceived as unpleasant and felt as abnormal. Dyspnea is one of the most common complaints faced by a hospitalist.
What is the differential diagnosis for this problem? Generally speaking, causes of dyspnea can be divided into: Pulmonary such as bronchospasm, pneumonia, pneumothorax, airway obstruction, pleural effusion, interstitial lung disease Cardiovascular congestive heart failure, myocardial infarction, cardiac tamponade, pulmonary embolism, arrhythmias Miscellaneous anemia, deconditioning, drugs, pregnancy, diabetic ketoacidosis, neurological, fractures, psychiatric causes, and obesity.
Discussions of all of the these etiologies are beyond the scope of this chapter.
Here, we will focus on the pathologies which hospitalists come across every day. These include pneumonia, bronchospasm chronic obstructive pulmonary disease COPDasthmacongestive heart failure, and pulmonary embolism PE. The diagnostic approach is discussed in detail below.
History information important in the diagnosis of this problem. In addition to obtaining general history, physicians should focus on associated cough, sputum production, hemoptysis, chest pain, wheezing, orthopnea, palpitations, abnormal weight loss, and generalized, ie. Patients should also be asked about acuity, severity, and frequency of their dyspneic episodes.
When evaluating a patient with shortness of breath, it is always important to consider life-threatening conditions and to stay vigilant that a heart attack, a pulmonary embolism, acutely decompensated heart failure, acute severe hypoxemia of various reasons, could happen at any time, in a hospitalized patient.
During the initial interview, all patients should be asked about their smoking history, also including the underlying second hand exposure which is usually associated with a previous similar episode.
Asthma and COPD are the most common obstructive lung diseases. Patients suffering from these conditions usually mention wheezing or chest tightness as a presenting complaint.
For example, a patient with an acute bronchoconstrictive episode, may describe a sense of chest tightness, even when their lung function is preserved. Patients with COPD have strong smoking history.
Any diseases of the chest wall, such as those which cause stiffness, such as kyphoscoliosis, or weakens the respiratory muscles, such as Guillain-Barre or myasthenia gravis, could also cause dyspnea.
Pleural effusions, whether as a stand alone diagnosis, or associated with other conditions, could also cause an increase in the work of breathing. Diseases of the lung parenchyma, such as pneumonia could also cause dyspnea. Diseases of the heart or pericardium could present with dyspnea.
Diastolic dysfunction, described as a stiff left ventricle, is also associated with severe dyspnea, even with minimal physical activity, especially if it associated with other valvulopathies, such as mitral regurgitation.
Constrictive pericarditis can present with an increased of the pulmonary and intracardiac pressures, followed by dyspnea. Cardiac tamponade has a similar mechanism. Venous thromboembolism, such as PE pulmonary embolism causes dyspnea.
Any other pulmonary disease, such as pulmonary hypertension, ILD interstitial lung diseasecould also be associated with increased work of breathing.
Myocardial infarction MI is usually associated with chest pain but silent MI described in elderly, women and diabetics is also a well-known cause of dyspnea. Patients usually have underlying risk factors of MI in such cases. Patients who suffer from anemia, could also present with anemia, especially during the high oxygen demand, such as physical activity.
Overweight patients can also become breathless. Hospitalized patients, with a prolonged length of stay, especially the elderly, may develop deconditioning, which could also manifest with breathlessness.Consumer Behaviour For Branded Clothing Essay Study On Diabetic With Exertional Dyspnea And Anasarca Essay, Ethics In The Modern Business World: A Case Study On Leisure Net Essay, Ethics In The Modern Business World: A Case Study On Leisure Net Essay African Psychology Essay, Toyota Industry Founder Is Sakichi Toyoda Essay.
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Explore. Sep 06, · A woman with multiple comorbidities, including heart failure, presents to the hospital with shortness of breath that has progressed to resting dyspnea. Case: A year-old obese woman with hypertension, diabetes, and scleroderma is referred for follow-up .
PHYSICAL DIAGNOSIS FINAL EXAM STUDY GUIDE. Download a copy of this study guide. Chapter 2: Head and Neck; Chapter 3: Respiratory EXERTIONAL DYSPNEA: Dyspnea on exertion is a common symptom of mild or severe Congestive Heart Failure. Anasarca: Severe generalized edema and ascites, as seen in severe CHF, liver .
Diabetic With Exertional Dyspnea and Anasarca: Case Study A fifty year old gentleman a known diabetic and hypertensive for eight years presented with exertional dyspnea of one month duration. Published: Thu, 04 Jan