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SHORTNESS OF BREATH

SHORTNESS OF BREATH. Dr Arjan Verdi. What is SOB?. The subjective symptom of breathlessness Essentially means that the body is not getting enough oxygen thus there is a increase in respiratory drive. What can cause SOB?. 2) Ventilation- perfusion mismatch

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SHORTNESS OF BREATH

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  1. SHORTNESS OF BREATH Dr Arjan Verdi

  2. What is SOB? • The subjective symptom of breathlessness • Essentially means that the body is not getting enough oxygen thus there is a increase in respiratory drive

  3. What can cause SOB? • 2) Ventilation- perfusion mismatch • Pulmonary oedema: HF, liver failure, nephrotic syndrome • Pneumonia • PEPulomary fibrosis • 1)Decrease O2 into the lungs • Obstruction: lung Ca, COPD, asthma, anaphylaxis • Lung compliance: restrictive lung disease- fibrosis • Lung space: pneumothorax, collapse • Diaphragm: Guillain Barre syndrome, myasthenia gravis • Chest wall: obesity, kyphoscoliosis

  4. What can cause SOB? • 3) Reduced oxygen transport • Reduced cardiac output: aortic stenosis, heart failure • Anaemia • Shock: haemorrhage, sepsis • 4)Other causes • Hyperventilation • Acidaemia (DKA)

  5. Hx of SOB key points • Speed onset • Seconds to minutes: anapylaxis, PE, pneumothorax, flash pulmonary oedema, hyperventilation • Hours to day: pneumonia, heart failure, pleural effusion, • Weeks to months: COPD, asthma, heart failure, fibrosis, anaemia, • Cough? • Persistent productive cough last few days ?pneumonia; few months in a smoker ?COPD • Dry cough at night ? Asthma • Pink frothy sputum ? Heart failure • Blood stained ?PE, pneumonia, brochiectasis, lung cancer

  6. Chest pain • Is it pleuritic ?pneumonia, pneumothorax, PE • Non- pleuritic ? CVS pathology • Red flag symptom • Weight loss, anorexia, night sweats- ? Cancer or TB • Alleviating/exacerbating symptoms: • Heart failure- orthopnoea • Asthma worse in summer/ dust • COPD worse in winter

  7. Risk factors • Smoking: pack years? • Pets: allergies, psittacosis • Occupation: asbestos, silica, dust, coal • Medication: amiodarone, methotrexate, cyclophosphamides, bleomycin, hydralazine, busulphan can cause pulmonary fibrosis

  8. Pneumonia • Lower respiratory tract infection • Symptoms: fever, rigors, sputum ,SOB, haemoptysis, • Signs: tachycardic, tachpnoeic , confused, reduced expansion, dull percussion, increase tactile vocal fremitus, bronchial breathing • Test; ABG, CXR, Sputum culture, bloods • Mx: IVI’s. Abx, analgesia , oxygen

  9. COPD • Obstruction of the airways with little/ no reversibility • SMOKING • Chronic bronchitis: a productive cough for everyday for 3 months for 2 consecutive years • Symptoms: cough, sputum, dyspnoea, wheeze • Signs: hyper expanded chest, pursed lipped breathing, reduced chest expansion and hyper resonant percusssion

  10. Heart failure • SOB on exertion, orthopnoea, PND • Risk factors: • ischaemic heart disease • atherosclerotic disease (TIA, limb claudication) • Hypertension • Valvular disease (rheumatic fever, endocarditis) • Cardiomyopathy • Signs on examination • Displaced apex • Third/fourth heart sounds • Bilateral crackles • Raised JVP, Hepatomegly, peripheral odema

  11. Pulmonary embolism • Usually from bloods clots in the legs or pelvis • Risk factors: • Surgery • Stroke and MI • Cancer • Immobility • Obesity • Pregnancy, post partum and HRT • Symptoms: SOB, pleurtic chest pain, haemoptysis, dizziness, syncope • Signs: tachycardic, tachypnoeic, raised JVP, pleural rub, • Look at pts legs

  12. Investigations • Bloods: • FBC- ?anaemia • WCC and CRP- ?Infection • D-dimer- ?PE • U&E’s- pt dehydrated or fluid overload • CXR: • Heart failure- ABCDE • Pneumonia- consolidation • Pneumothorax or collapse • ABG- respiratory failure type 1 or 2 • Peak expiratory flow rate: act as a baseline and grade severity

  13. References • Oxford cases in Medicine an surgery by Farne, Norrise-Cervetto, Warbrick-Smith • Oxford Clinical Medicine by Murray Longmore

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