my cardiac and chest symptoms
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Symptoms of Cardiac &
Respiratory Diseases
Metabolism Department
Alexandria University
Mohammed Zeitoun
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Dyspnea
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Subjective feeling of difficulty in breathing
concerning the rate, rhythm or depth of
respiration.
Dyspnea
Definition:
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How do the patient describe dyspnea
Cannot get enough air.
Air does not go all the way down.
Tightness in the chest.
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Grade I: Difficulty of breathing on doing MORE
than the usual daily effort (Physiological).
Grade II: Difficulty of breathing on doing the
usual daily effort.
Grade III: Difficulty of breathing on doing LESS
than the usual daily effort.
Grade IV: Difficulty of breathing at rest.
Grades of Dyspnea
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With Exercise.
Causes of Dyspnea
Physiological:
Cardiac Causes: e.g. Left Heart Failure, PericardialEffusion.
Pathological:
Pulmonary Causes: ANY Chest Disease e.g.Pneumonia, Bronchial Asthma, Lung Collapse,
Pulmonary Fibrosis, Pulmonary Embolism, . .
History of emotional stress, commonly in females.
Diagnosed by Exclusion of Organic Causes.
Psychogenic: (Hysterical)
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Causes of Dyspnea
Pulmonary
Pulmonary embolism
Obstructive lung disease
Interstitial lung disease
Pleural effusion
Pneumonia
Acute Bronchitis
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Toxic dyspnea
The overdose of morphine and pentobarbital candepress respiratory center causing slow respiration.
Haematologicl dyspnea
The decrease of oxygen-carrying capacity and
oxygen content develop abnormal respiration and
increase heart rate, such as severe anemia,carbon monoxide.
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Differential Diagnosis
Composed of four general categories
Cardiac
Pulmonary
Mixed cardiac or pulmonary
non-cardiac or non-pulmonary
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Noncardiac or NonpulmonaryEtiology
Metabolic conditions (e.g. acidosis)
Pain
Trauma
Neuromuscular disorders
Functional(anxiety,panic disorders,
hyperventilation)
Chemical exposure
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Accompanying symptoms
Paroxysmal dyspnea with wheezing
It is present in: Bronchial asthma.
Cardiac asthma.
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Accompanying symptoms
Dyspnea with chest pain
It is frequently observed in:
Lobar pneumonia.
Pulmonary infarction.
Spontaneous pneumothorax.
Acute myocardial infarction.
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Accompanying symptoms
Dyspnea with fever
It is frequently observed in:
Pneumonia
Lung abscess.
Pleurisy
Acute pericarditis
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Accompanying symptoms
Dyspnea with cough & purulent sputum
It is frequently observed in:
Chronic bronchitis.
Emphysema.
Purulent pneumonia
Lung abscess.
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Accompanying symptoms
Dyspnea with large amount of
foamy sputum
is often seen in:
Acute left ventricular heart failure
Organo-phosphorus poisoning.
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Orthopnea
Definition: Difficulty in breathing in the supineposition; relived by sitting up.
Mechanism: Reduce the degree of pulmonary congestion by
pooling blood in the lower extremities
Improve the diaphragmatic movement
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Orthopnea
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Paroxysmal nocturnal dyspnea
Definition: respiratory distress that awakenspatients from sleep in hunger to air (usually
occurs 2 to 4 hours after onset of sleep) compelsthe patient to sit upright or stand.
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In cases where test results inconclusive
Complete PFTs
ABGs
EKG
Exercise treadmill testing.
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There is no single specific treatment for dyspnea.
Treatment varies according to patients condition
Chief complaint.
History.
Exam.
Laboratory & radiological study results.
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Chest Pain
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Site.
Radiation. Character.
Duration.
Precipitating Factors.
Relieving Factors.
Associated Symptoms.
Chest Pain
Comment on Chest pain:
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Site: Retrosternal.
Radiation: Left Shoulder, Left Arm, neck or jaw. Character: Tightness, heaviness or Squeezing.
Duration: Minutes
Precipitating Factors: Exercise or Emotional Stress
Relieving Factors: Rest or SL Nitroglycerine
Associated Symptoms: Sweating & Palpitation
Chest Pain
e.g. Anginal Pain:
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A careful history is the single most important
means of diagnosing angina.
The typical patient is a middle-aged or elderly
man or woman with one or more of the cardio-
vascular risk factors (smoking, hypertension or
dyslipidemia)
Chest Pain
e.g. Anginal Pain:
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CHD: Angina Pectoris & Myocardial Infarction.
Pericarditis.
Dissecting Aortic Aneurysm.
Causes of Chest Pain
Cardiac Causes:
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Chest Wall: e.g. Fracture Ribs, Myositis, Neuralgia.
Pleuro-Pulmonary: e.g. Pleurisy, Pneumothorax,Pulmonary Embolism.
Mediastinum: e.g. Mediastinitis, Oesophageal
malignancy, Oesophageal Spasm.
Diaphragm: e.g. hiatus Hernia
Abdomen: e.g. Cholecystitis, Subphrenic Abscess.
Causes of Chest Pain
Non-Cardiac Causes:
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Palpitation
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syncope
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Cardiac syncope
Syncope is a sudden transient loss of
consciousness and postural tone with
spontaneous recovery.
Restoration of appropriate behavior andorientation after a syncopal episode is usually
immediate.
Retrograde amnesia is uncommon.
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Cardiac syncope
Syncope is an important clinical problem because it is a
common, costly, often disabling, may cause injury, and
may be the only warning sign before sudden cardiac
death ( SCD).
Neuro-cardiogenic syncope may have an early warning
(nausea , yawning).
The patient appears pale and diaphoretic, and revive
more slowly, without signs of seizure or a prolongedpost-ictal state.
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Cough
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Cough is an explosive expiratory maneuver that isreflexively intended to clearthe airways.
Coughing is a normal response to the presence ofmucus or other foreign material in the airway or
upper airway, but persistent coughing is annoying
and generally indicates irritation of the pulmonary
airways.
Cough is a deep expiratory effort against a closedglottis, which opens suddenly, with a jet of air.
Cough
Definition:
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It brings out sputum.
It should not be suppressed.
Types of Cough
Productive Cough:
It brings no sputum.
It should be suppressed as it is useless.
Dry Cough:
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Cough
How long had the cough been present?
Is the cough worse at any time of day or
night?
Dry cough at night bronchial asthma? Is the cough aggravated by anything, for
example dust pollen or cold air?
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Evaluation of Cough
URI and sinus symptoms suggest postnasal dripsyndrome, but postnasal drip can causes cough
without other symptoms.
Heartburn, hoarseness, and chronic nocturnal or earlymorning cough, especially if no other symptoms arepresent, suggests GERD.
Cough after exposure to dusts or allergens suggests
Bronchial Asthma. Chronic cough with production of purulent sputum in
smokers suggests Chronic Bbronchitis. A change in
cough in these patients may, however, be an early
manifestation ofLung Cancer.
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It is the passage of sputum out of the
respiratory tract.
Expectoration
Definition:
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Expectoration
Is sputum produced?
What does it look like?
How much is produced?
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Per 24 hours e.g. 5CC, 15CC, 30CC, 100CC,200CC.
Comment on Expectoration
Amount:
Yellowish: Bacterial infection e.g. Streptococci
Colour:
Fetid sputum indicates infection with anaerobicbacteria.
Odour:
Greenish: Pseudomonas.
Black: Pneumoconiosis or Smokers.
White: Allergic (BA), Viral infection.
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Mucoid: Bronchial Asthma.
Mucopurulent: Bronchitis, Pneumonia.
Purulent: Suppurative lung diseases e.g. Lungabscess, Bronchiectasis.
Frothy Blood-tinged: Pulmonary Oedema.
Comment on Expectoration
Aspect (Consistency):
Mostly in the morning e.g. Bronchiectasis.
Time of Occurrence:
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Haemoptysis
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It is Coughing ofBlood originating from Below
the Vocal Cords.
Haemoptysis
Definition:
Bleeding originating from Above the VocalCords is considered False Haemoptysis.
Haemoptysis may range from Blood-streakedSputum to Frank Haemoptysis.
C f H t i
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Traumatic: e.g. Foreign Body.
Causes of Haemoptysis
Respiratory Causes:
Inflammatory:
- Specific: e.g. TB
- Non-Specific: e.g. Bronchitis, Pneumonia,Bronchiectasis, Lung Abscess
Neoplastic:
- Benign: e.g. Bronchial Adenoma.- Malignant: e.g. Bronchogenic Carcinoma.
Vascular:
- Pulmonary Embolism.
- Pulmonary Oedema.
C f H t i
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Mitral Stenosis. Left Heart Failure.
Aortic Aneurysm weeping into a bronchus.
Causes of Haemoptysis
Cardio-Vascular Causes:
Haemophilia. Leukemia.
General Causes: Haemorrhagic Diseases
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D.D. between Haemoptysis & Haematemesis
HaematemesisHaemoptysis
Vomiting of BloodCoughing of BloodDefinition
Dark Brown
(Acid Haematin)
Bright Red
(Oxyhaemoglobin)Color
Mixed with Food ParticlesFrothyNature
AcidicAlkalineReaction
MelenaBlood-tinged SputumAfter the
attack
H t i
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Haemoptysis
Is there is any blood in the sputum?
Is it fresh or altered?
How often has it been seen?
For how long?
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Wheezing
Wh i
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Wheezing
Do you hear any noises coming from
the chest?
Sometimes wheezing is noticed by
others (especially by a partner at
night when asthma is worse).
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Questions ?