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Dyspnea: Differential Diagnosis

Dyspnea: Differential Diagnosis. Cyril Štěchovský Dept. of Cardiology 2.LF UK a FNM. Dyspnea. Symptom – shortness of breath Sign – abnormal respiratory effort. Dyspnea is a symptom of disorder at different levels Central nervous system Ventilation Diffusion Pulmonary perfusion

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Dyspnea: Differential Diagnosis

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  1. Dyspnea: Differential Diagnosis Cyril Štěchovský Dept. of Cardiology 2.LF UK a FNM

  2. Dyspnea • Symptom – shortness of breath • Sign – abnormal respiratory effort

  3. Dyspnea is a symptom of disorder at different levels • Central nervous system • Ventilation • Diffusion • Pulmonary perfusion • Oxygen transportation • Cellular oxygenation

  4. Central disorders • Hypoxemia • Hypercapnia • Stroke • Encephalitis • Tumor • Intoxication • Anxiety

  5. Disorders of ventilation and diffusion • Neuromuscular disorders • Trauma • Exhaustion • Airway obstruction • Laryngospasm • COPD • Bronchial asthma • Tumor • Foreign body • Restrictive pulmonary disorders - fibrosis • Atelectasis • Pneumonia • Pulmonary congestion / edema • Fluidothorax • Pneumothorax • Esophageal hernia • Pulmonary resection • Chest deformity • High diaphragm

  6. Disorders of pulmonary perfusion • Pulmonary embolism • Pulmonary hypertension

  7. Disorders of oxygen transportation and utilization • Anemia • Methemoglobinemia • Carboxyhemoglobinemia • Cyanide intoxication

  8. Others • Pain • Decondition • Hyperthyreosis • Fever

  9. Pulmonary edema • Fluid excess in pulmonary interstitium and alveoli

  10. Pulmonary edema • Cardiac – increased LVEDP (PCWP) • Noncardiac (ARDS) – inflammation, „leaky“ alveolocapillary membrane • Inhaled toxins, aspiration, sepsis, oxygen toxicity, pancreatits, traumatic shock

  11. DDx • History • Physical examination • Paleness (anemia), cyanosis • Respiratory rate, heart rate, BP, body temperature • Respiratory effort • Lungs and heart auscultation • Peripheral edema • Pulse oximetry • Chest x-ray

  12. DDx • Complete blood count • ECG • Arterial blood gases • ECHO • Spirometry • Chest CT scan • Spiroergometry

  13. Arterial blood gases analysis • pH • Saturation • pO2 • pCO2 • Bicarbonate • Lactate • Anion gap • Base excess • Hemoglobin

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