10748046
Aisha is not feeling so good
- Shortness of breath - Dyspnea
- Definition : An intense tightening in the chest, air hunger or a feeling of suffocation.
- Normally arises when
:
- Very strenuous exercise
- Extreme temperatures
- Massive obesity
- High altitude
- Very strenuous exercise
- Pathological causes
- Acute
- CO poisoning
- Hypotension
- Pulmonary embolism
- Cardiac tamponade
- Heart failure
- Pneumothorax
- Pneumonia
- Hemorrhage
- CO poisoning
- Chronic
- Asthma
- COPD
- Heart dysfunction
- Interstitial lung disease
- Renal impairment
- Obesity
- Asthma
- Acute
- Types
- Orthopnea
- Sensation of
breathlessness in the
recumbent position,
relieved by sitting or
standing
- Patient will increase the number
of pillows at night to avoid
becoming dyspnoeic due to the
accumulation of fluid & edema
- Edema
- What is edema?
- The accumulation of fluid in the interstitial space.
- The accumulation of fluid in the interstitial space.
- Types
- Transudate :Filtration (starling forces).
- Exudate: increase in vascular permeability.
- Transudate :Filtration (starling forces).
- Causes of edema
- What is edema?
- Edema
- Sensation of
breathlessness in the
recumbent position,
relieved by sitting or
standing
- Paroxysmal nocturnal Dyspnea
- Sensation of
shortness of breath
that awakens the
patient, often after 1
or 2 hours of sleep.
- Sensation of
shortness of breath
that awakens the
patient, often after 1
or 2 hours of sleep.
- Orthopnea
- Definition : An intense tightening in the chest, air hunger or a feeling of suffocation.
- Heart Failure
- Lifestyle risk
factors
- Smoking
- Diabetes
- Hypertension
- Hyperlipidemia
- Smoking
- Types of heart
failure
- Left sided heart failure
- Heart failur with reduced ejection
fraction: The left venticle loses
ability to contract, the heart loses
ability to contract normally.
- Heart failure with preserved ejection fraction:
The left venticle loses its ability to properly
fill with blood thus the heart does not pump
enough blood into the circulation.
- Heart failur with reduced ejection
fraction: The left venticle loses
ability to contract, the heart loses
ability to contract normally.
- Right sided heart failure
- Usually occurs With association
of left sided heart hailure.
- Usually occurs With association
of left sided heart hailure.
- Congestive heart failure
- Covers and used
interchangebly with
LHF & RHF
- Covers and used
interchangebly with
LHF & RHF
- Left sided heart failure
- Prognosis
- Poor prognosis
- Poor prognosis
- History taking
- Physical
examination
- General Inspection (signs of shortness of breath)
- Blood pressure measurement (High- 168/102)
- Hands: Tar stain, peripheral
cyanosis.
- Assessment of pulse: Rate (tachycardia- 95), rhythm (irregular), character (pulsus alternans),
- Face : Mitral facies,
xanthelasmata
- Eyes: Icterus/ jaundice
- Mouth: central
cyanosis
- Lower limbs: Pitting edema
- Auscultation: S3 & S4.
- The back:: Percuss
(dull), auscultate
(crackles, wheezing).
- Neck : elevated JVP = High
arterial pressure,
Hepatojugular reflex (higher
level > few seconds).
- General Inspection (signs of shortness of breath)
- Investigations
- Chest X-ray findings
- Congestion in the upper lobes
- Perihilar congestion
- Fluffy alveolar infiltrates
- Kerley lines
- Air bronchograms
- Congestion in the upper lobes
- ECG
- Echocardiogram
- Chest X-ray findings
- Treatment
- Frusemide
- Loop diuretics that act on the Na+-K+-2Cl− symporter (cotransporter) in the thick ascending limb of the
loop of Henle to inhibit sodium, chloride and potassium reabsorption.
- Loop diuretics that act on the Na+-K+-2Cl− symporter (cotransporter) in the thick ascending limb of the
loop of Henle to inhibit sodium, chloride and potassium reabsorption.
- Common Side
effects
- Vomiting, diarrhea, fever, chills, or nausea.
- Muscle pain, cramps, or weakness.
- Irregular heartbeat.
- Ototoxicity
- Headache
- Vomiting, diarrhea, fever, chills, or nausea.
- Enalapril
- After hydrolysis to enalaprilat, inhibits angiotensin-converting enzyme (ACE) a peptidyl dipeptidase
that catalyzes the conversion of angiotensin I to the vasoconstrictor substance, angiotensin II.
- After hydrolysis to enalaprilat, inhibits angiotensin-converting enzyme (ACE) a peptidyl dipeptidase
that catalyzes the conversion of angiotensin I to the vasoconstrictor substance, angiotensin II.
- Carvedolil
- Carvedilol is used to prevent further worsening of congestive heart failure. It is also used to treat
left ventricular dysfunction after a heart attack.
- Carvedilol is used to prevent further worsening of congestive heart failure. It is also used to treat
left ventricular dysfunction after a heart attack.
- Frusemide
- Lifestyle risk
factors
- Transtheoretical model
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