DYSPNEA - Universitas...
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DYSPNEA DYSPNEA Menaldi Rasmin Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, University of Indonesia Persahabatan Hospital, Jakarta
Transcript of DYSPNEA - Universitas...
DYSPNEADYSPNEA
Menaldi Rasmin
Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, University of Indonesia
Persahabatan Hospital, Jakarta
Diagnosis
Dyspnea: • Discomfort feeling in breathing
• Subjective and difficult to measure
• Etiology : lung, heart, endocrine, kidney, neurology, hematology, rheumatology and psichology
• Prevalence of dyspnea → no accurate data
INTRODUCTIONINTRODUCTION
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Diagnosis
VENTILATORY REGULATIONVENTILATORY REGULATION
• located in the medulla of the brainstem• composed of several subcenters, that interact to
produce rhytmical breathing• output is transmitted to phrenic nerves to diaphragm
and respiratory muscles• affected by
• Higher cortical centers• Mechanical• Chemical stimuli
Ventilatory Central Centre
Diagnosis
Cortical CentersCortical Centers• input to the ventilatory center• result; breathing partially under voluntary control
Mechanical reflexes
• emanate from skeletal muscle spindle• pulmonary vessels and tissue
Diagnosis
DyspneaDyspnea• breathlessness• shortness of breath• uncomfortable or unpleasant
respiratory-related sensation
• not tachypnea, not hyperpnea and not hyperventilation but; difficult, labored, uncomfortable breathing; it is unpleasant type of breathing though not painful in the usual sense of the word.It is subjective and, like pain, it involves both perception of the sensation by the patient and his reaction to the sensation
Comroe (1966)
Diagnosis
“ “ an uncomfortable awareness of breathing an uncomfortable awareness of breathing or an increased respiratory effort that is or an increased respiratory effort that is
unpleasant and regarded as in appropriate” unpleasant and regarded as in appropriate” (Mahler et al 1984)(Mahler et al 1984)
DEFINITION OF DYSPNEADEFINITION OF DYSPNEA
The American Thoracic Society (ATS):
the term of discomfort perception subjective in breathing that consist of sensation with different intensity as a results of interaction of various physiologic, social and environtmental factors.
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Diagnosis
MECHANISM OF DYSPNEAMECHANISM OF DYSPNEA
• Interaction between signal and receptor in otonomic nerve system, motoric cortex,airway receptor, lung and thoracic cage →dyspnea
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Diagnosis
MECHANISM OF DYSPNEAMECHANISM OF DYSPNEA
Dyspnea
Complex of breathing
Lung and thoracic cage
CognitiveBehavior
Emotion
Chemoreceptor stimulation
Exercise
Primary motoric cortex
Primary sensoric corte
Diagnosis
MECHANISM OF DYSPNEAMECHANISM OF DYSPNEA
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MEASUREMENT OF DYSPNEAMEASUREMENT OF DYSPNEA• Aim : to differentiate the severity and to
evaluate the nature of dyspnea • Technique of measurement :
– visual analogue scale– Borg scale– Medical Research Council (MRC) Dyspnea
Scale– American Thoracic Sosiety (ATS) Dyspnea
Scale – Baseline Dyspnea Index (BDI) – Transitional Dyspnea Index (TDI)
Diagnosis
ATS dyspnea indexATS dyspnea index• Grade 1 : No dyspnea except severe exercise activity
• Grade 2 : Dyspnea when climb the step in hurry or climb lsmall hilla
• Grade 3 : Walk slower compared to common people• Grade 4 : Must stop for breathing after 100 yard walk• Grade 5 : Dyspnea while puput on / off the clothes
Dyspnea pulmonary non-pulmonary
(cardiac) *pulm edema *arrhythmias *asthma/COPD *acute MI *PE *myocardial ishemia *pneumonia *pneumothorax
DYSPNEA IN PULMONARY DYSPNEA IN PULMONARY DISEASEDISEASE
• Abnormality of breathing mechanism, lung become more stiff, weakness of ventilation muscles.
• Restrictive lung diseases.• Obstructive lung diseases.• Disturbance of lung diffusion.• Disturbance of lung perfusion.
RESTRICTIVE LUNG DISEASERESTRICTIVE LUNG DISEASE
• Lung : - atelectasis - fibrosis - lung tumour - bullae - lung abscess
• Mediastinum : - mediastinal tumour - cardiomegali - pericardial effusion
Diagnosis
ATELECTASISATELECTASIS
Diagnosis
PANCOAST TUMORPANCOAST TUMOR
Diagnosis
LUNG ABSCESSLUNG ABSCESS
Diagnosis
Diagnosis
DESTROYED LUNGDESTROYED LUNG
Diagnosis
BULLAEBULLAE
Diagnosis
BULLAEBULLAE
RESTRICTIVE LUNG DISEASERESTRICTIVE LUNG DISEASE
• Pleura : - pleural effusion - pleural tumour - pneumothorax • Diaphragm : - hernia of diaphragm - paralize of diaphragm• Bone : - rib fracture - pectus excavatum - scoliosis, kyphosis• Muscle : - myasthenia gravis
Diagnosis
PLEURAL EFUSSIONPLEURAL EFUSSION
Diagnosis
PNEUMOTHORAXPNEUMOTHORAX
Diagnosis
HYDROPNEUMOTHORAXHYDROPNEUMOTHORAX
OBSTRUCTIVE LUNG DISEASEOBSTRUCTIVE LUNG DISEASE
• Asthma• COPD : - Chronic bronchitis - Emphysema• Bronchiectasis• Lung tumour• Foreign body
Diagnosis
BRONCHIECTASISBRONCHIECTASIS
Diagnosis
LUNG TUMORLUNG TUMOR
DISTURBANCE OF DIFFUSIONDISTURBANCE OF DIFFUSION
• Alveolar wall• Interstitial space• Arterial wall• Plasma• Red blood cell wall
Diagnosis
PNEUMONIAPNEUMONIA
Diagnosis
ARDSARDS
DISTURBANCE OF DISTURBANCE OF PERFUSSIONPERFUSSION
• Pulmonary emboli• Congestive heart failure
Diagnosis
LUNG NODULESLUNG NODULES
Diagnosis
MILLIARY TBMILLIARY TB
Diagnosis
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CONCLUSIONCONCLUSION
• Dyspnea is a subjective symptom• Various abnormalities may cause dyspnea• Severity of dyspnea can be measured
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