Dyspnea is difficulty in breathing (respiration) and the patient is unpleasantly aware of this. Dyspnea on effort is a comrnon problem. Ask the patient if he is breatl~less when climbing stairs, going up a gradient or walking on a flat surface at a normal pace. Can the patient keep up with colleagues or is there a need to slow down. Assess the number of stairs he can climb or the distance walked before breathlessness occurs.
Dyspnea is usually due to congestion from heart failure or chronic pulmonary disease.Anxiety may contribute to it. Acute dyspnea may occur as in flash pulmonary edema,pulmonary embalism, acute pneumothorax, airway obstruction or asthma.Many dyspneic patients are comfortable only on sitting up (orthopnea). Some may find that they are particularly breatl~less when lying on one side (trepopnea). In heart failure the central blood volume is increased on lying supine. This stimulates the receptors in the atrium and the lungs, producing breathlessness.
Paroxysmal Nocturnal Dyspnea (PND) starts during sleep, conlmonly 2-3 hours after retiring. Patient gets breathless and needs to sit up or even walk about or open a window. It can progress from mild breathlessness to frank pulmonary edema.Clinicnl Evaluation Cough with or without wheezing inay accompany dyspnea. The sputum may be watery with a little froth and pink blood. On the other hand, a day irritative cough suggests the side effect of ACE inhibitors.
Hemoptysis may be present with raised pulmonary venous pressure as in mitral stenosis or LV failure.Cheyne-Stokes breathing is a forni of periodic respiration with shallow respiratioll slowing increasing in depth to hyperpnea and returning to shallow breathing again. It occurs during sleep.Sleep-apnea syndroine is due to obstruction of the naso-pharyngeal region and may be associated with high blood pressure. Strictly speaking Cheyne-Stokes respiration and sleep-apnea is not dyspnea, as there is no subjective sensation. Wheezing associated with dyspnea is called cardiac asthma.Rarely, the patient may be worse off when sitting or standing as in atrial myxoma or the ball of a prosthetic valve may block the mitral valve orifice due to gravity in the vertical position. The grading dyspnea is given in Table and its causes in Table
Dyspnea is usually due to congestion from heart failure or chronic pulmonary disease.Anxiety may contribute to it. Acute dyspnea may occur as in flash pulmonary edema,pulmonary embalism, acute pneumothorax, airway obstruction or asthma.Many dyspneic patients are comfortable only on sitting up (orthopnea). Some may find that they are particularly breatl~less when lying on one side (trepopnea). In heart failure the central blood volume is increased on lying supine. This stimulates the receptors in the atrium and the lungs, producing breathlessness.
Paroxysmal Nocturnal Dyspnea (PND) starts during sleep, conlmonly 2-3 hours after retiring. Patient gets breathless and needs to sit up or even walk about or open a window. It can progress from mild breathlessness to frank pulmonary edema.Clinicnl Evaluation Cough with or without wheezing inay accompany dyspnea. The sputum may be watery with a little froth and pink blood. On the other hand, a day irritative cough suggests the side effect of ACE inhibitors.
Hemoptysis may be present with raised pulmonary venous pressure as in mitral stenosis or LV failure.Cheyne-Stokes breathing is a forni of periodic respiration with shallow respiratioll slowing increasing in depth to hyperpnea and returning to shallow breathing again. It occurs during sleep.Sleep-apnea syndroine is due to obstruction of the naso-pharyngeal region and may be associated with high blood pressure. Strictly speaking Cheyne-Stokes respiration and sleep-apnea is not dyspnea, as there is no subjective sensation. Wheezing associated with dyspnea is called cardiac asthma.Rarely, the patient may be worse off when sitting or standing as in atrial myxoma or the ball of a prosthetic valve may block the mitral valve orifice due to gravity in the vertical position. The grading dyspnea is given in Table and its causes in Table
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