my cardiac and chest symptoms

7/27/2019 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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Dyspnea with chest pain

It is frequently observed in:

Lobar pneumonia.

Pulmonary infarction.

Spontaneous pneumothorax.

Acute myocardial infarction.


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Dyspnea with fever


Pneumonia

Lung abscess.

Pleurisy

Acute pericarditis


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Dyspnea with cough & purulent sputum


Chronic bronchitis.

Emphysema.

Purulent pneumonia

Lung abscess.


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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 ?

my cardiac and chest symptoms

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