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SPECIFIC TYPES OF

DYSPNEA
 PAROXYMAL NOCTURNAL DYSNPNEA
 ORTHOPNEA
 TREPOPNEA
 PLATYPNEA
PAROXYMAL NOCTURNAL
DYSPNEA
Also known as CARDIAC ASTHMA

Characterized by attacks of severe


shortness
of breath that occur at night and
usually
awakens the patient from sleep
Mechanism
Reabsorption of edema from dependent position of body

Increase in total blood volume

Increased pulmonary venous pressure

Thickening of the walls of pulmonary vessels

Competition of space among vessels, airways & increased fluid in


interstitial space

Compression of small airway

Increased airway resistance

Increased work of breathing

Dyspnea
Nocturnal dyspnea forms

o Nocturnal dyspnea in chronic bronchitis


 characterised by hypersecretion of mucus
and production of wheezing
o Nocturnal dyspnea in asthma
 Severe between 2am and 4am in the morning
 Patient wakes up with sense of suffocation
,extreme dyspnea and wheezing
ORTHOPNEA
 Dyspnea that occurs in supine position
 The cause is the effect of gravitational
forces that elevates the pulmonary venous
and capillary pressure
 Seen in cases of
 CHF
 Severely obese individual
 Bilateral phrenic nerve palsy
 Diaphragmatic disorder
TREPOPNEA

 Dyspnea that is relieved when the


patient is in lateral recumbent
position
PLATYPNEA
 Dyspnea that occurs only in upright
position
 Seen in cases of
 Chronic liver disease
 Pulmonary arteriovenous metastasis
ACCORDING TO TIME AND
CHRONICITY
 INSTANTANEOUS:
 Pneumothorax
 Pulmonary embolism

• Acute (minutes - hrs):


 Metabolic acidosis
 Cardiac disease
 Hyperventilation
syndrome
 Subacute(days):
 Pleural effusion
 Lobar collapse
 SVC obstruction
 Acute interstitial pneumonia

 Chronic (mon-years):
 COPD
 Bronchial asthma
 Sarcoidosis
 Bronchiectasis
 Anemia
 Obesity
 Thyrotoxicosis
DIFFERENTIAL DIAGNOSIS
The first aim of diagnosis is to
differentiate between two main types
of dyspnea

ACUTE DYSNEA

CHRONIC EXERTIONAL DYSPNEA


Acute severe dyspnea
CONDITION HISTORY SIGNS CHEST ARTERIAL ECG
RADIOGRAPHY BLOOD GASES

Pulmonary Chest pain Central cyanosis Cardiomegaly Pao2 v Sinus


edema Orthopnea Jvp^ Plueral effusion Paco2 v tachycardia
palpitations sweating Overt edema Signs of MI

Massive Recent surgery Central cyanosis Subtle changes Pao2 vv Sinus


pulmonary Chest pain ^jvp only Paco2 v tachycardia
embolus dizziness trachycardia

Acute severe Wheeze Tachycardia Hyperinflation Pao2 v Sinus


asthma Previous Jvp only Paco2 v tachycardia
episodes rhonchi
Acute Previous Cyanosis Hyperinflation Pao2 v Signs of
exacerbation of episodes Signs of COPD and Signs of Paco2 ^ right
COPD co2 retention emphysema ^bicarbonate ventricle
strain

pneumonia Fever Fever Pneumonic Pao2 v tachycardia


Rigors Confusion consolidation Paco2 v
pleurisy Pleural rub
consolidation
Metabolic Evidence of renal Fetor normal Pao2 normal
acidosis or diabetes Hyperventilation Paco2 vv
Over dose of Dehydration pH vv
aspirin Kussumaul’s
respiration
psychogenic Previous Not cyanosed normal Pao2 normal
episodes No heart signs Paco2 vv
No lung signs pH >^
CHRONIC EXERTIONAL
DYSPNEA
 COPD
 Chronic asthma
 Heart disease
 Interstitial or alveolar disease of lung
 Disease of chest wall or respiratory
muscles
 Pulmonary thromboembolism

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