The patient comes to your attention because he has shortness of breath and asthenia.
Why does he tell you that he moves a few steps and gasps? Or that
goes up a flight of stairs and must stop step by step, leaning on the handrail?
What are the causes that underlie the problems of breathing?
1. from primitive diseases of the bronchopulmonary apparatus
2. from heart disease or interesting the pulmonary circle
3. from diseases of the respiratory centers
4. from neuromuscular diseases
5. from clinical situations (different from the previous ones) that determine an
inadequate oxygen supply to the tissues (for example an anemia).
The most common type of dyspnea occurs during physical exertion; ventilation is increased and maintained by increasing the respiratory stimulus, generated by metabolic factors and other undefined factors. Dyspnoea is also common during acute hypoxia, as occurs at high altitudes where increased respiratory stimulation. Hypoxaemia is a stimulus for increasing significantly weaker ventilation compared to hypercapnia.
Lung cancer on the left: it's documented extensive
consolidation that massively affects the inferior
pulmonary lobe of sn.
Lung cancer can give pictures that simulate acute bronchopneumonia, with
thickening that never heals. The symptoms can vary depending on whether the
tumor affects the central parts and large bronchi, having bronco-occlusion,
ulceration of the bronchus wall and central necrosis. At other times the patient
presents a broncostenosi serrata (see auscultation of the chest) and listen to
the hissing dry noises, while the subject strains the respiratory muscles and
engages them all and gasps, has always breathlessness and hunger for air and
calls for an increase in speed of the oxygen in TAC lung, on the right lung with
appearance of mucinosomaschera adenocarcinoma. Bronchostenosis is a cause of
atelectasis and bronchial ectasia, but also of suppurative facts, of pneumonia
and abscesses. If the bronchus is ulcerated, hemoptysis will appear,
The two main causes of pulmonary dyspnea are represented by:
- restrictive alteration with low compliance of the lungs or thoracic cavity
- from an obstructive alteration with increased resistance to airflow.
Patients with restrictive dyspnea (eg, due to pulmonary fibrosis or chest
deformity) usually do not experience discomfort in resting breathing, but are
intensely dyspnoic when for lung activity physical ventilation is close to
maximum respiratory capacity. In obstructive dyspnea (eg, in obstructive
emphysema or asthma).
In the early stages of heart failure, cardiac output can not keep up with the
increased metabolic demand during exercise. Non-cardiogenic pulmonary edema or
adult respiratory distress syndrome produce a similar clinical picture through
similar, but more acutely, mechanisms. Cardiac asthma is a state of acute
respiratory failure with bronchospasm, wheezing and hyperventilation. It may be
indistinguishable from other types of asthma, but the cause is left ventricular
decompensation. This is why it distinguishes between:
- antegrade heart failure = "Low output failure" (reduction of systolic spurt in
time unit)
- retrograde heart failure (blood stagnation in front of the respective half of
the heart)
- insufficiency in the presence of hypercirculation = "High out-put failure" (eg
in the presence of hyperthyroidism, anemia).
The "air hunger" (acute dyspnea that occurs in the terminal
stages of bleeding bleeding) is a serious sign that requires immediate
transfusion therapy. Dyspnoea also appears in chronic anemia, but only during
exercise, unless the anemia is of extreme severity.
Diabetic acidosis (blood pH 7.2 to 6.95) induces a characteristic, slow and deep breath (Kussmaul breath). However, since the respiratory capacity is well preserved, the patient rarely complains of dyspnoea. In contrast, in the uremia the patient may complain of dyspnea due to severe tachypnoea induced by the combination of acidosis, heart failure, pulmonary edema and anemia.
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Ingestion pneumonia: large area of parenchymal thickening in the ilo-perilary site with engagement of the lingular, apical and medial segments and posterior posterior of the left lower lobe, of phlogistic nature; extended area of parenchymal thickening objectified to the middle-lower pulmonary field dx; thickened and congested; |
Brain injuries (eg, haemorrhage) can cause intense hyperventilation, sometimes
noisy and stertorous. Occasionally, irregular periods of apnea alternate with
periods in which four or five breaths of equal depth (Biot's breath) are
performed. Hyperventilation is frequently observed after head injury. The
decreased PaCO2 causes a reflexed vasoconstriction of the CNS with reduced
cerebral perfusion, leading to a beneficial secondary decrease in intracranial
pressure. Ingested pneumonia should also be considered.
In certain forms of anxiety, the patient feels as if the breath is insufficient and reacts to this hyperventilating sensation. Hyperventilation can be continuous and manifest, causing acute alkalosis by removal of CO2. Generalized anxiety disorder does not necessarily arise in response to external stimuli, even if stressful events or an overall unfavorable environment can degenerate or aggravate its manifestations. Just like depression, the origin of anxiety disorder is linked to the altered functioning of some brain circuits, not yet fully known, but which at least partly involve the system of serotonin and norepinephrine. Anxiety disorder can occur at any time in life, often at particularly critical transition periods or when faced with difficult choices. The sufferers are mainly women (affected twice as often as men), children and the elderly (especially if suffering from chronic diseases).
index pneumology