Shortness of breath , also known as dyspnea , is a feeling that one can not breathe well enough. The American Thoracic Society defines it as "a subjective experience of breathing discomfort consisting of qualitatively different sensations that vary in intensity," and recommends evaluating dyspnea by assessing the intensity of different sensations, the degree of difficulty involved, and the burden or impact. on the activities of daily life. Different sensations include effort/work, chest tightness, and hunger in the air (not enough oxygen sensation).
Dyspnea is a normal symptom of strenuous activity but becomes pathological if it occurs in unexpected situations or exertion. In 85% of cases it is caused by asthma, pneumonia, cardiac ischemia, interstitial lung disease, congestive heart failure, chronic obstructive pulmonary disease, or psychogenic causes, such as panic disorder and anxiety. Treatment usually depends on the underlying cause.
Video Shortness of breath
Definisi
The American Thoracic Society defines dyspnea as: "The subjective experience of breathing discomfort consists of different sensations qualitatively varying in intensity." Other definitions describe it as "difficulty breathing", "irregular or inadequate breathing", "uncomfortable consciousness breathing", and as a "shortness of breath" experience (which may be acute or chronic).
Maps Shortness of breath
Differential diagnosis
While shortness of breath is generally caused by disruption of the heart or respiratory system, other systems such as neurological, musculoskeletal, endocrine, haematological, and psychiatric may be the cause. DiagnosisPro, an online medical expert system, noted 497 different causes in October 2010. The most common cardiovascular causes are acute myocardial infarction and congestive heart failure while common lung causes include chronic obstructive pulmonary disease, asthma, pneumothorax, pulmonary edema and pneumonia. Pathophysiologically the cause can be divided into: (1) increased normal breathing awareness such as during anxiety attacks, (2) increased respiratory work and (3) abnormalities in the ventilation system.
acute coronary syndrome
Acute coronary syndromes often appear with retrosternal chest discomfort and difficulty catching breath. But perhaps atypically present with shortness of breath alone. Risk factors include old age, smoking, hypertension, hyperlipidemia, and diabetes. Electrocardiogram and cardiac enzymes are important both for diagnosis and direct treatment. Treatment involves action to reduce the need for cardiac oxygen and efforts to improve blood flow.
Congestive congestive heart failure
Congestive heart failure often presents with shortness of breath with exertion, orthopnea, and paroxysmal nocturnal dyspnea. It affects between 1-2% of the general population of the United States and occurs in 10% of those over 65 years of age. Risk factors for acute decompensation include high food salt intake, medication non-compliance, cardiac ischemia, dysrhythmias, renal failure, pulmonary embolism, hypertension, and infection. Treatment efforts directed to reduce lung congestion.
Chronic obstructive pulmonary disease
People with chronic obstructive pulmonary disease (COPD), usually emphysema or chronic bronchitis, often have chronic breathlessness and chronic productive cough. Acute exacerbations appear with increased breathlessness and sputum production. COPD is a risk factor for pneumonia; thus this condition must be set aside. In the treatment of acute exacerbations is by combination of anticholinergic, beta 2 -adrenoceptor agonist, steroid and possibility of positive pressure ventilation.
Asthma
Asthma is the most common reason to come to the emergency room with shortness of breath. It is the most common lung disease in both developing and developing countries that affects about 5% of the population. Other symptoms include wheezing, tightness in the chest, and an unproductive cough. Inhaled corticosteroids are the preferred treatment for children, but they can reduce growth rates. The acute symptoms are treated with short-acting bronchodilators.
Pneumothorax
Pneumothorax usually presents with acute onset chest pain and breathlessness does not improve with oxygen. Physical findings may include breath sounds that are absent on one side of the chest, jugular venous distension, and tracheal deviation.
Pneumonia
Symptoms of pneumonia are fever, productive cough, shortness of breath, and pleuritic chest pain. Inspirational rituals can be heard during the exam. Chest X-ray can be useful for distinguishing pneumonia from congestive heart failure. Since the cause is usually a bacterial infection, antibiotics are usually used for treatment.
The severity and prognosis of pneumonia can be estimated from CURB65, where C = Confusion, U = Uremia (& gt; 7), R = respiratory rate & gt; 30, B = BP & lt; 90, 65 = Age & gt; 65.
Pulmonary embolism
Classic pulmonary embolus appears with acute onset of shortness of breath. Other symptoms that appear include pleuritic chest pain, cough, hemoptysis, and fever. Risk factors include deep vein thrombosis, recent surgery, cancer, and previous thromboembolism. It should always be considered in those with acute onset of shortness of breath due to the high risk of death. But diagnosis may be difficult and Wells Scores are often used to assess clinical probabilities. Treatment, depending on the severity of symptoms, usually begins with anticoagulants; the presence of unpleasant signs (low blood pressure) may require the use of thrombolytic drugs.
Anemia
Gradually developing anemia usually presents with dyspnea during activity, fatigue, weakness, and tachycardia. This can lead to heart failure. Anemia caused by low hemoglobin levels is often the cause of dyspnea. Menstruation, especially if excessive, can cause anemia and dyspnea as a result in women. Headache is also a symptom of dyspnea in patients suffering from anemia. Some patients report a sensation of numbness in their head, and others report blurred vision caused by hypotension behind the eyes due to lack of oxygen and pressure; these patients also report severe headaches, many of which cause permanent brain damage. Symptoms can include loss of concentration, focus, fatigue, impaired language skills and memory loss.
More
Other important or common causes of breathlessness include cardiac tamponade, anaphylaxis, interstitial lung disease, panic attacks, and pulmonary hypertension. Cardiac tamponade presents with dyspnea, tachycardia, increased jugular venous pressure, and pulsus paradoxus. The gold standard for diagnosis is ultrasound. Anaphylaxis usually begins for a few minutes in someone with the same previous history. Other symptoms include urticaria, swelling of the throat, and gastrointestinal disorders. The main treatment is epinephrine. Interstitial lung disease presents with gradual onset of breathlessness usually with a history of predisposing environmental exposure. Shortness of breath is often the only symptom in those with tachydysrhythmias. Panic attacks usually present with hyperventilation, sweating, and numbness. Yet they are an exception diagnosis. About 2/3 of women experience shortness of breath as part of a normal pregnancy. Neurological conditions such as spinal cord injury, phrenic nerve injury, Guillain-Barrà © Å © syndrome, amyotrophic lateral sclerosis, multiple sclerosis and muscular dystrophy can all cause a person to experience shortness of breath. Shortness of breath can also occur due to vocal cord dysfunction (VCD cord).
Pathophysiology
Different physiological pathways can cause shortness of breath including through chemoreceptors ASIC, mechanoreceptors, and pulmonary receptors.
It is estimated that three major components contribute to dyspnea: afferent signals, efferent signals, and central information processing. It is believed that central processing in the brain compares afferent and efferent signals; and dyspnoea occurs when a "mismatch" occurs between the two: as when the need for ventilation (afferent signaling) is not met by physical respiration (the efferent signal).
Afferent signals are sensory nerve signals that rise to the brain. Significant afferent neurons in dyspnea arise from a large number of sources including carotid bodies, medulla, lungs, and chest wall. Chemoreceptors in the carotid and medullary bodies provide information on blood gas levels of O 2 , CO 2 and H . In the lungs, juxtacapillary (J) receptors are sensitive to pulmonary interstitial edema, while stretching receptors signify bronchoconstriction. Spindles of muscles in the chest wall signify stretching and tension of the respiratory muscles. Thus, poor ventilation leads to hypercapnia, left heart failure that causes interstitial edema (damaging gas exchange), asthma that causes bronchoconstriction (restricted air flow) and muscle fatigue causing ineffective respiratory muscle actions all may contribute to dyspnea feeling.
An efferent signal is a motor neuronal signal that descends into the respiratory muscles. The most important respiratory muscle is the diaphragm. Other respiratory muscles include external and internal intercostal muscles, abdominal muscles and accessory respiratory muscles.
When the brain receives a vast supply of afferent information related to ventilation, it can compare it with the current rate of respiration as determined by the efferent signal. If the respiratory rate is not appropriate for body status, then dyspnea may occur. There is also a psychological component to dyspnea, as some people may be aware of their breathing under such circumstances but do not experience the distinctive distress of dyspnea.
Evaluation
The initial approach to evaluation begins with the assessment of airway, breathing, and circulation followed by medical history and physical examination. Signs that represent significant severity include hypotension, hypoxemia, tracheal deviation, altered mental status, unstable dysrhythmias, stridor, intercostal indrawing, cyanosis, tripod position, accessory muscle use (sternocleidomastoid, scalena) and non-existent breathing sounds.
A number of scales can be used to measure the level of shortness of breath. This can be assessed subjectively on a scale of 1-10 with the number-related descriptor (The Modified Borg Scale). Or a scale like the breathless scale of MRC might be used - it shows five levels of dyspnea based on the state in which it appears.
Blood tests
A number of laboratories may be helpful in determining the cause of shortness of breath. D-dimers while useful to get rid of pulmonary embolism in those at low risk are not much value if positive as they may be positive in a number of conditions that cause shortness of breath. Low-level brain natriuretic peptide is useful in overriding congestive heart failure; However, high rates while supporting the diagnosis may also be due to old age, kidney failure, acute coronary syndrome, or large pulmonary embolism.
Imaging
Chest x-rays are useful for confirming or getting rid of pneumothorax, pulmonary edema, or pneumonia. Spiral computed tomography with intravenous radiocontrast is the imaging study of choice for evaluating pulmonary embolism.
Treatment
In those who are not palliative, the main treatment for shortness of breath is directed at the underlying cause. Extra oxygen is effective in those with hypoxia; However, this has no effect on those with normal blood oxygen saturation, even in those who are palliative.
Physiotherapy
Individuals can benefit from various physical therapy interventions. People with neurological/neuromuscular disorders may experience difficulty breathing due to weak or paralyzing intercostal muscles, abdominal and/or other muscles needed for ventilation. Several physical therapeutic interventions for this population include active cough support techniques, volume augmentation such as breath buildup, education of body position and ventilation patterns and movement strategies to facilitate breathing.
Palliative
Along with the above measures, systemic release opioids are immediately useful in reducing the symptoms of shortness of breath due to cancer and non-cancer causes; long-acting/sustained-release opioids are also used to prevent/continue dyspnea treatment in palliative settings. Pulmonary rehabilitation may relieve symptoms in some people, such as those with COPD, but will not cure the underlying illness. Lack of evidence to recommend midazolam, nebulisation opioids, use of gas mixtures, or cognitive behavioral therapy.
Epidemiology
Shortness of breath is the main reason 3.5% of people present to the emergency department in the United States. Of these people, about 51% are hospitalized and 13% die within a year. Some studies suggest that up to 27% of people suffer from dyspnea, while in patients who are dying 75% will experience it. Acute shortness of breath is the most common reason people need palliative care visit the emergency department.
Etymology and pronunciation
The English dyspnea is derived from the Latin dyspnoea , from the Greek dyspnoia , from dyspnoos , which literally means " irregular breathing ". The merging form ( dys - -pnea ) is familiar from other medical words, such as dysfunction ( dys - < i> function ) and apnea ( a - -pnea ). The most common pronunciation in medical English is disp- NEE -? , with p p in pn (as in pneumo - ) is common ( or ), as well as those who have pressure on the first syllable ( or ).
In English, the various -pnea words - commonly used in medicine do not follow a clear pattern, whether the first syllable or syllable:/tribe is suppressed; p is usually expressed but sometimes silent. The following collation shows the dominance of how the main dictionary transcribes it (rarely used variants are omitted):
Regarding p in Greek - pn -, one recipe states that it is silent only when the initial word, not when intersyllabic; by this principle, though silence in pneumatics will be heard in one of the pneas-a term is strung together. The instability of this principle can be descriptively true to ancient Greece, but not descriptively true to English.
See also
- Glossary of lung size and activity
- Ortopnea
References
Source of the article : Wikipedia
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