Notes by dr Claudio Italiano
Many people, especially the elderly, but sometimes even small children and the small child, can suffer from this symptom, that is, this external sign, which hides in reality some very insidious pathologies.
Technically, the strictly
respiratory "hunger of air" is called dispnéa, which means, from the Greek, the
bad breath, and it is the subjective sensation of difficulty in breathing. But
the patient who tells you he has trouble is not always a "respiratory" patient.
Often behind this symptom hides an insidious heart disease!
There are different types of dyspnea that, depending on the mode of onset, are
divided into:
acute forms
continuous forms
chronic forms re-exacerbated
So acute dyspnea recognizes:
1. primitive diseases of the bronchopulmonary apparatus
2. heart disease or interesting the pulmonary circle
3. diseases of the respiratory centers
4. neuromuscular diseases
5. clinical situations (different from the previous ones) that determine an
inadequate oxygen supply to the tissues (eg anemia)
It's based on the difficulty of breathing during the inspiratory phase or during the expiratory phase.
We classified dyspnea into:
- inspiratory dyspnea
-expiratory dyspnea
-mixed dyspnea
Whatever the pathogenesis, the dyspnoea depends on the alteration of the oxygenation
of the blood with low oxygen pressure and little elimination of carbon dioxide,
due to pulmonary and / or ventilatory decompensation, therefore insufficiency of
the respiratory function.
The absolute diagnostic criteria, to show that there is dyspnea (the presence of
at least 2 of the following criteria is required) are:
I. PaO2 <55 mmHg
II. PaCO2> 50mmHg (excluding compensatory hypercapnia of metabolic alkalosis)
III. Arterial ph <7.35
IV. Acute alteration of frequency and respiratory amplitude
The pathologies that imply it can generally be summarized in:
-Asthma and allergy (see auscultation of the asthmatic patient)
-Cardiovascular disease and angina (see also decompensation, arrhythmias, heart
attack);
in these patient cardiopaths, one can notice an aggravating asthenia, that is
a fatigue even at the minimum efforts, for example that of climbing a flight of
stairs, or, in the most serious cases, the patient sleeps in bed, in orthopnea;
if he walks, he can only take a few steps and often has swollen ankles, legs
heavy with liquids and a pretibial edema that the doctor shows through the sign
of the fovea, that is crushing the edematous area with a fingertip, will remain
a dimple, defined from the Latin "fovea" or also called "fingerprint mark"
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