Dyspnea: Differential Diagnosis Cyril Štěchovský Dept. of Cardiology 2.LF UK a FNM.
-
Upload
hope-gilbert -
Category
Documents
-
view
212 -
download
0
Transcript of Dyspnea: Differential Diagnosis Cyril Štěchovský Dept. of Cardiology 2.LF UK a FNM.
![Page 1: Dyspnea: Differential Diagnosis Cyril Štěchovský Dept. of Cardiology 2.LF UK a FNM.](https://reader036.fdocuments.us/reader036/viewer/2022072014/56649eb45503460f94bbbeb0/html5/thumbnails/1.jpg)
Dyspnea: Differential Diagnosis
Cyril Štěchovský
Dept. of Cardiology 2.LF UK a FNM
![Page 2: Dyspnea: Differential Diagnosis Cyril Štěchovský Dept. of Cardiology 2.LF UK a FNM.](https://reader036.fdocuments.us/reader036/viewer/2022072014/56649eb45503460f94bbbeb0/html5/thumbnails/2.jpg)
Dyspnea
• Symptom – shortness of breath• Sign – abnormal respiratory effort
![Page 3: Dyspnea: Differential Diagnosis Cyril Štěchovský Dept. of Cardiology 2.LF UK a FNM.](https://reader036.fdocuments.us/reader036/viewer/2022072014/56649eb45503460f94bbbeb0/html5/thumbnails/3.jpg)
Dyspnea is a symptom of disorder at different levels•Central nervous system•Ventilation•Diffusion•Pulmonary perfusion•Oxygen transportation•Cellular oxygenation
![Page 4: Dyspnea: Differential Diagnosis Cyril Štěchovský Dept. of Cardiology 2.LF UK a FNM.](https://reader036.fdocuments.us/reader036/viewer/2022072014/56649eb45503460f94bbbeb0/html5/thumbnails/4.jpg)
Central disorders
• Hypoxemia• Hypercapnia• Stroke• Encephalitis• Tumor• Intoxication• Anxiety
![Page 5: Dyspnea: Differential Diagnosis Cyril Štěchovský Dept. of Cardiology 2.LF UK a FNM.](https://reader036.fdocuments.us/reader036/viewer/2022072014/56649eb45503460f94bbbeb0/html5/thumbnails/5.jpg)
Disorders of ventilation and diffusion
• Neuromuscular disorders• Trauma• Exhaustion• Airway obstruction
– Laryngospasm– COPD– Bronchial asthma– Tumor– Foreign body
• Restrictive pulmonary disorders - fibrosis
• Atelectasis• Pneumonia• Pulmonary congestion / edema• Fluidothorax• Pneumothorax• Esophageal hernia• Pulmonary resection• Chest deformity• High diaphragm
![Page 6: Dyspnea: Differential Diagnosis Cyril Štěchovský Dept. of Cardiology 2.LF UK a FNM.](https://reader036.fdocuments.us/reader036/viewer/2022072014/56649eb45503460f94bbbeb0/html5/thumbnails/6.jpg)
Disorders of pulmonary perfusion
• Pulmonary embolism• Pulmonary hypertension
![Page 7: Dyspnea: Differential Diagnosis Cyril Štěchovský Dept. of Cardiology 2.LF UK a FNM.](https://reader036.fdocuments.us/reader036/viewer/2022072014/56649eb45503460f94bbbeb0/html5/thumbnails/7.jpg)
Disorders of oxygen transportation and utilization
• Anemia• Methemoglobinemia• Carboxyhemoglobinemia• Cyanide intoxication
![Page 8: Dyspnea: Differential Diagnosis Cyril Štěchovský Dept. of Cardiology 2.LF UK a FNM.](https://reader036.fdocuments.us/reader036/viewer/2022072014/56649eb45503460f94bbbeb0/html5/thumbnails/8.jpg)
Others
• Pain• Decondition• Hyperthyreosis• Fever
![Page 9: Dyspnea: Differential Diagnosis Cyril Štěchovský Dept. of Cardiology 2.LF UK a FNM.](https://reader036.fdocuments.us/reader036/viewer/2022072014/56649eb45503460f94bbbeb0/html5/thumbnails/9.jpg)
Pulmonary edema• Fluid excess in pulmonary interstitium and
alveoli
![Page 10: Dyspnea: Differential Diagnosis Cyril Štěchovský Dept. of Cardiology 2.LF UK a FNM.](https://reader036.fdocuments.us/reader036/viewer/2022072014/56649eb45503460f94bbbeb0/html5/thumbnails/10.jpg)
Pulmonary edema
• Cardiac – increased LVEDP (PCWP)• Noncardiac (ARDS) – inflammation, „leaky“
alveolocapillary membrane– Inhaled toxins, aspiration, sepsis, oxygen toxicity,
pancreatits, traumatic shock
![Page 11: Dyspnea: Differential Diagnosis Cyril Štěchovský Dept. of Cardiology 2.LF UK a FNM.](https://reader036.fdocuments.us/reader036/viewer/2022072014/56649eb45503460f94bbbeb0/html5/thumbnails/11.jpg)
DDx
• History• Physical examination– Paleness (anemia), cyanosis– Respiratory rate, heart rate, BP, body temperature– Respiratory effort– Lungs and heart auscultation – Peripheral edema
• Pulse oximetry• Chest x-ray
![Page 12: Dyspnea: Differential Diagnosis Cyril Štěchovský Dept. of Cardiology 2.LF UK a FNM.](https://reader036.fdocuments.us/reader036/viewer/2022072014/56649eb45503460f94bbbeb0/html5/thumbnails/12.jpg)
DDx
• Complete blood count• ECG• Arterial blood gases• ECHO• Spirometry• Chest CT scan• Spiroergometry
![Page 13: Dyspnea: Differential Diagnosis Cyril Štěchovský Dept. of Cardiology 2.LF UK a FNM.](https://reader036.fdocuments.us/reader036/viewer/2022072014/56649eb45503460f94bbbeb0/html5/thumbnails/13.jpg)
Arterial blood gases analysis
• pH• Saturation• pO2• pCO2• Bicarbonate• Lactate• Anion gap• Base excess• Hemoglobin