((Shortness of breath))
Vishtasb khalili
Shortness of breath , known medically as dyspnea , is often described
as an intense tightening(become stiff) in the chest, air hunger,
difficulty breathing, breathlessness or a feeling of suffocation.
Shortness of breath, or dyspnea, is a painless but uncomfortable
awareness of breathing that is inappropriate to the level of exertion.
Rating of perceived exertion (RPE) can help you measure how hard your
body is working when you exercise.
base the number on how tired you are, how hard it is to breathe, and how hard it is
to do the activity.
Causes of shortness of breath
• The oxygen that the person needs is taken
from the air passes through the nose to the
lungs, then in the lung passes to the blood
and reaches to the heart. It disperses into
the tissues and organs in the body through
the arteries emerging from the heart.
• All these events is regulated by the brain.
Shortness of breath develops in any disease
or disorder that prevents oxygen reaching to
the tissues. Causes of shortness of breath
can be classified in 3 categories as: lung,
heart and other non-cardiac
• When Should I See a Doctor?
• If shortness of breath keeps you from doing your regular daily
activities, that’s reason enough to call the doctor.
• But definitely schedule an appointment if you have trouble breathing
along with any of these symptoms:
• Shortness of breath when you’re resting or lying down
• Fever, chills, night sweats
• Fast, fluttering heartbeats
• Wheezing
Tests to Diagnose Shortness of Breath
https://www.webmd.com/lung/breathing-problems-diagnosis#2
• At your appointment, your doctor will ask a few questions about your
medical history and do a physical exam. This might include listening to
your heart and lungs for signs of congestion, murmur, or anything else
unusual.
• The results of the exam may lead her to order a few tests to help
figure out what else might be causing your breathing problems.
Chest X-ray.
It can show the doctor signs of conditions such as
pneumonia or other heart and lung problems.
Pneumonia
lung inflammation caused
by bacterial or viral
infection, in which the air
sacs fill with pus and may
become solid. Inflammation
may affect both lungs
( double pneumonia ) or
only one ( single pneumonia
).
• Oxygen test.
• Also called pulse oximetry, this helps your doctor measure how much
oxygen is in your blood. She’ll place a clothespin-like sensor on your
finger, which uses light to detect oxygen. Other than the pressure of
the sensor, you won’t feel anything.
• Electrocardiography (EKG).
• You might get this test in your doctor’s office or a
hospital. A technician will attach small electrodes to
your chest with gel or tape, and a machine will
measure the electrical impulses that make your
heart beat. An EKG can show your doctor if blood
flow to the heart is impaired.
• The most common heart disorders causing
shortness of breath:
• Heart failure
• Heart attack
• Cardiac tamponade (accumulation of fluid around
the heart).
• Lung function test. This measures how well your lungs work and lets your
doctor know if something is blocking or keeping them from using air properly. It
can also show how well your lungs can transport and use oxygen. One type of
lung function test is called spirometry. You breathe into a mouthpiece that
connects to a machine and measures your lung capacity and air flow. Your
doctor may also have you stand in a box that looks like a telephone booth to
check your lung capacity. This is called plethysmography. Each of these tests
helps your doctor diagnose problems such as asthma, emphysema, or COPD.
Chronic obstructive pulmonary disease (COPD) is a lung
disease characterized by chronic obstruction of lung airflow
• Asthma is a chronic, or long-term, condition that intermittently
inflames and narrows the airways in the lungs. The inflammation
makes the airways swell.
• Asthma causes periods of wheezing, chest tightness, shortness of
breath, and coughing.
• Emphysema is a lung condition that causes shortness of breath.
• In people with emphysema, the air sacs in the lungs (alveoli) are
damaged. Over time, the inner walls of the air sacs weaken and rupture
creating larger air spaces instead of many small ones.
• Blood test.
• A doctor or nurse will use a needle to take
blood from a vein in your arm and send it to a
lab for tests. The results can tell them whether
or not conditions such as anemia or heart
failure are making you short of breath.
• How Can Anemia make you feel short of
breath?
• Hemoglobin is an iron-rich protein that helps
red blood cells carry oxygen from the lungs to
the rest of the body. If you have anemia, your
body does not get enough oxygen-rich blood.
This can cause you to feel tired or
weak. You may also have shortness of breath,
dizziness, headaches, or an irregular heartbeat.
Begin by observing the patient for signs of respiratory distress.
• Assess the respiratory rate for tachypnea (>25 breaths/minute).
(healthy resting adult breathes quietly and regularly about 20 times a minute )
Tachypnea increases the likelihood of
pneumonia and cardiac disease.
• Inspect the patient’s color for cyanosis or pallor. Recall earlier
relevant findings, such as the shape and color of the fingernails.
• Cyanosis in the lips, tongue, and oral
mucosa signals hypoxia. Pallor and
sweating (diaphoresis) are common in
heart failure.
• occurs in bronchiectasis, congenital heart disease, pulmonary fibrosis,
lung abscess, and ….
• Listen for audible sounds of breathing. Is there audible whistling
during inspiration over the neck or lungs?
• Audible high-pitched inspiratory whistling, or stridor, is an ominous
sign of upper airway obstruction in the larynx
or trachea that requires urgent airway
evaluation.
• Inspect the neck. During inspiration, is there contraction of the accessory muscles, namely the
SCM and scalene muscles, or supraclavicular retraction?
During expiration, is there contraction of the intercostal or abdominal
oblique muscles? Is the trachea midline?
• Accessory muscle use signals difficulty breathing from COPD or respiratory muscle fatigue.
Lateral displacement of the trachea occurs in pneumothorax, pleural effusion, and ….
Examination of the Posterior Chest
• Inspection. Standing in a midline position behind the
patient, note the shape
of the chest and how the chest moves
• Asymmetric expansion occurs in large
pleural effusions.
Abnormal muscle retraction of the intercostal spaces during
inspiration,most visible in the lower intercostal spaces
(Retraction occurs in severe asthma,COPD, or upper airway
obstruction )
Palpation. As you palpate the chest, focus on areas of
tenderness
• Intercostal tenderness can develop
over inflamed pleurae, costal cartilage
tenderness in costochondritis.
• Test chest expansion.
• Place your
thumbs at about the level of the
10th ribs
•
Ask the patient to inhale deeply. Watch the distance
between your thumbs as they move apart during inspiration,
and feel for the range and symmetry of the rib cage as it
expands and contracts.
• This movement is sometimes called lung excursion.
• Unilateral decrease or delay in chest
expansion occurs in chronic fibrosis of
the underlying lung or pleura, pleural
effusion
• Percussion helps you establish whether the underlying tissues
are air-filled, fluid-filled, or consolidated.
The percussion blow penetrates only 5 to 7 cm into the chest,
however, and will
not aid in detection of deep-seated lesions.
Dullness replaces resonance when fluid
or solid tissue replaces air-containing
lung or occupies the pleural space
beneath your percussing fingers.
Examples include: lobar pneumonia, in
which the alveoli are filled with fluid
• Generalized hyperresonance is common over the
hyperinflated lungs of
COPD or asthma. Unilateral hyperresonance suggests a large
pneumothorax
or an air-filled bulla.
• Auscultation is the most important examination technique for
assessing air flow through the tracheobronchial tree. Auscultation
involves
(1) listening to the sounds generated by breathing
• (2) listening for any adventitious
(added) sounds
• (3) if abnormalities are suspected, listening to the sounds of
the patient’s spoken or whispered voice as they are transmitted
through the chest
wall
Before beginning auscultation, ask the patient to cough once or twice to clear
mild atelectasis or airway mucus that can produce unimportant extra sounds.
Breath sounds may be decreased when air flow is decreased (as in
obstructive lung disease or respiratory muscle weakness) or when
the transmission of sound is poor (as in pleural effusion,
pneumothorax, or COPD)
