Dyspnea

Dyspnea • Dyspnea or shortness of breath is an abnormal awareness of

respiration• Dyspnea in heart disease is precipitated or exacerbated by

exertion but may occur at rest• It results from elevated left atrial and pulmonary venous pressure• Hypoxia• Result of left ventricular systolic or diastolic dysfunction• Valvular obstruction

Grading of dyspnea by (NYH)Grade 1 No breathlessness

Grade 2 Breathlessness on severe exertion

Grade 3 Breathlessness on mild exertion

Grade 4 Breathlessness at rest

Types of cardiac dyspnea

• There are three type of cardiac dyspnea

• Acute pulmonary edema• Angina equivalent• Chronic heart failular

Acute pulmonary edema

• Develops from • Acute myocardial infarction (in previously healthy heart)• Atrial fibrillation (in previously heart disease)

• Symptoms Suddenly develop shortness of breath

Distress

Agitation Cyanosis with coughing Wheezing Sputum may profuseFrothy of blood-streaked or pink Heart auscultation reveals

crepitation and rhonchi

Angina equivalent

• When shortness of breath is the dominant or sole feature of myocardial ischemia instead of chest pain this is called angina equivalent

• In old people present ischemia with shortness of breath without feature of pulmonary edema

• ECG show st change • Treatment of angina relieves shortness of breath even

without diuretics

Shortness of breath (dyspnea)System Acute dyspnea at rest Chronic exertional

dyspnea Cardiovascular Acute pulmonary edema

Myocardia ischemia (angina may present just with dyspnea and this presentation is called angina equivalent)

Chronic heart failureMyocardial ischemia (angina may present jut dystaca and this presentation is called angina equivalent)

Chronic heart failure

• Orthopnea is dyspnea that occur during supine position (recumbency) as a result from increase venous return

Paroxysmal Nocturnal dyspnea (PND) is the shortness of breath that occurs abruptly 30 min to 2 hours after going to bed and is relieved by sitting up or standing up