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Dyspnea Differentials

Left sided heart failure: What is the process? Elevated pressure in the pulmonary capillary bed with transudation of fluid into interstitial spaces and alveoli, decreased compliance (increased stiffness) of the lungs, increased work of breathing
Left sided heart failure: Timing? may progress slowly or suddenly as in acute pulmonary edema
Left sided heart failure: Aggravating factors? exertion, lying down
Left sided heart failure: Relieving factors? rest, sitting up but may be persistent
Left sided heart failure: Associated symptoms? often cough, orthopnea, paroxysmal nocturnal dyspnea, sometimes wheezing
Left sided heart failure: Setting? history of heart disease or its predisposing factors
Chronic bronchitis: What is the process? excessive mucous production in bronchi, followed by chronic obstruction of airways
Chronic bronchitis: Timing? chronic productive cough followed by slowly progressive dyspnea
Chronic bronchitis: Aggravating factors? exertion, inhaled irritants, respiratory infections
Chronic bronchitis: Relieving factors? expectoration; rest; though dyspnea may become persistent
Chronic bronchitis: Associated symptoms? chronic productive cough, recurrent respiratory infections; wheezing may develop
Chronic bronchitis: Setting? history of smoking, air pollutants, recurrent respiratory infections
COPD: What is the process? overdistention of air spaces distal to terminal bronchioles, with destruction of alveolar septa, alveolar enlargement and limitation of expiratory air flow
COPD: Timing? slowly progressive dyspnea; relatively mild cough later
COPD: Aggravating factors? exertion
COPD: Relieving factors? rest, dyspnea may become persistent
COPD: Associated symptoms?
COPD: Setting? history of smoking, air pollutants, sometimes a familial deficiency in alpha1- antitrypsin
Asthma: What is the process? reversible bronchial hyperresponsiveness involving release of inflammatory mediators, increased airway secretions, and bronchoconstrictions
Asthma: Timing? acute episodes, separated by symptoms free periods. nocturnal episodes common
Asthma: Aggravating factors? allergens, irritants, respiratory infections exercise, emotions, cold air
Asthma: Relieving factors? separation from aggravating factors
Asthma: Associated symptom? wheezing, cough, tightness in chest
Asthma: Setting? environmental and emotional conditions
Diffuse interstitial Lung Disease: What is the process? abnormal and widespread infiltration of cells, fluid and collagen into interstitial spaces between alveoli
Diffuse interstitial Lung Disease: Timing?
Diffuse interstitial Lung Disease: Aggravating factors? exertion, same as with COPD and bronchitis
Diffuse interstitial Lung Disease: Relieving factors? rest, dyspnea may become persistent, same as with left sided HF, and COPD
Diffuse interstitial Lung Disease: Associated symptoms? often weakness, fatigue, cough less common than in other lung diseases
Diffuse interstitial Lung Disease: Setting? Varies, exposure to trigger substances
Pneumonia: What is the process? inflammation of the lung parenchyma from the respiratory bronchioles to the alveoli
Pneumonia: Timing? an acute illness, timing varies wit the causative agent
Pneumonia: Associated symptoms? pleuritic pain, cough, sputum, fever, though not necessarily present
Spontaneuous pneumothorax: What is the process? leakage of air into pleural space through blebs on visceral pleura, with resulting partial or complete collapse of the lung
Spontaneuous pneumothorax: Timing? sudden onset of dyspnea
Spontaneous pneumothorax: Associated symptoms? pleuritic pain, cough
Spontaneous pneumothorax: Setting? often a previously healthy adult
Acute pulmonary embolism: What is the process? sudden occlusion of all or part of pulmonary arterial tree by a blood clot that usually origniates in deep veins of legs or pelvis
Acute pulmonary embolism: Timing? sudden onset of dyspnea, same as with a pneumo, and anxeity
Acute pulmonary embolism: Associated symptoms? often none, restrosternal oppressive pain if the occlusion is massive. pleuritic pain cough and hemoptysis may follow an embolism if pulmonary infarction ensues. anxiety
Acute pulmonary embolism: Setting? postpartum or postoperatie periods; prolong bedrest; heart failure, chronic lung disease, and factures of hip or leg; DVT
Anxiety with hyperventilation: What is the process? overbreathing, with resultant respiratory alkalosis and fall in arterial partial pressure of cobon dioxide (pCO2)
Anxiety with hyperventilation: Timing? eposodic, often recurrent
Anxiety with hyperventilation: Aggravating factors? often occurs at rest, an upsetting even may not be evident
Anxiety with hyperventilation: Relieving factors? breathing in and out of a paper or plastic bag may help
Anxiety with hyperventilation: Associated symptoms?
Anxiety with hyperventilation: Setting? other manifestations of anxiety may be present, such as chest pain diaphoresis, palpitations
Created by: cljohnson2000



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