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Dyspnea
Dyspnea Differentials
| Question | Answer |
|---|---|
| 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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