Download Dyspnea

Respiratory Symptoms
Zhao Li, M.D.
Common symptoms
 Cough
 Expectoration
 Hemoptysis
 Chest pain
 Cyanosis
 Dyspnea
Cough (a protective reflex): causes
 Respiratory diseases___ the most common causes
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Airway agents
 Bronchitis, bronchiectasis, asthma, endobronchial
tuberculosis, tumor, pharyngitis
Lung agents
 Infection, edema, fibrosis, tumor
Pleural agents
 Pleurisy, pneumothorax, mesothelioma of pleura
 Cardiovascular diseases

Cardiogenesis edema, pulmonary embolism
 Central nervous system agents

Initiative cough, encephalitis, meningitis
Cough : manifestations
 Characteristics
 Dry cough (non-sputum: non-infectious)
 Productive cough (sputum: infectious, edema)
 Attack
 Time
 season
 motivation
 Tone
 Hoarseness
 High pitch
 Weak
 Brassy
Cough: accompany signs
 Fever (infection)
 Chest pain (infection, tumor, pleurisy,
pneumothorax, pulmo embolism)
 Dyspnea
 Hemoptysis (bronchietasis, tuberculosis, tumor)
 Bulk pus sputum (bronchietasis, lung abscess)
 Wheezing (asthma, foreign body)
 Clubbing fingers (bronchietasis, lung cancer,
chronic lung abscess)
Sputum: amount
 Bulk frothy sputum
 Pulmo edema
 Bulk serofluid sputum
 Alveolar carcinoma
 Bulk pus sputum
 Bronchiectasis
 Lung abscess
Layering
upper: frothy,
middle: mucoid or mucopus,
lower: necrosis substance
Sputum: consistency
 Mucoid sputum
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Bronchitis (without bacterial infection)
Asthma
Early stage of pneumonia
 Serofluid sputum

Pulmo edema
 Pus sputum

Any bacterial infection
 Bloody sputum
Sputum: color
 White

mucoid or serofluid sputum
 Yellow

general bacterial infection
 Green

aeruginosus Bacillus infection
 Grey
oror
black
Grey
black

dust inhalation
 Rusty

Lobar pneumonia
 Pink

cardiac edema
 Red

hemoptysis
Sputum: foul odor
 anaerobic bacterium infection
Hemoptysis
 Bleeding from lower respiratory tract
 The amount varies from blood-strained sputum to several
hundreds ml pure blood

Mild: 100ml/d
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Moderate: 100-500/d
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Severe: >500ml/d, or 100-500/time
 Differential diagnosis

Bleeding from upper respiratory tract

Hematemesis
Distinguished hemoptysis from
hematemesis
Hemoptysis
Hematemesis
Causes
Pulmo or cardiac
digestive system
Previous symptoms
Cough, chest tightness
Nausea, vomiting
Spit up
Cough up
Vomited
Color
Bright red
Dark red
Mixture
Sputum, frothy
Gastric contents
pH
alkality
acidity
Tarry stools
- or +
+
Post-bleeding
Sputum with blood
No sputum
Hemoptysis: causes
 Bronchial disorders


Bronchiectasis
Bronchogenic carcinoma
endobronchial TB
 Chronic bronchitis
 Pulmo Disorders
 Pulmo TB
 Peumonia


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Lung abscess
Pulmo embolism
 Cardiovascular disorders

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Acute left heart failure
Mitral stenosis
 Others
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Hematologic disease, leptospirosis （钩端螺旋体病），
epidemic hemorrhagic fever，endometriosis （子宫内膜异位症）
Hemoptysis: accompany signs
 Fever

Infection or carcinoma
 Chest pain

Infection， Pulmo Embolism，Carcinoma
 Pus sputum

Bronchiectasis，Lung abscess
 Clubbing fingers

Bronchiectasis，Lung abscess，Carcinoma
 Hemorrhagic spots
 Hematologic disease, leptospirosis, epidemic
hemorrhagic fever
Chest pain: causes
 Chest wall
herpes zoster, rib fracture
Cardiovascular
 angina pectoris, myocardial infarction, pericarditis, dissecting
aneurysm （夹层动脉瘤）
Respiratory
 Pleural disorders, pneumothorax, carcinoma
Mediastinal
 Mediastinitis, mediastinal emphysema, mediastinal tumor
Others
 esophageal carcinoma, liver abscess, subdiaphragmatic
abscess, hiatal hernia （食道裂孔疝）
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Chest pain: characteristics
 location
 Referred pain
 Level or feature

Burning pain, pressing pain, bursting pain,
pricking pain
 Duration
 Influential factors

Exertional, respiration, foodintake, administration
Chest pain: accompany signs
 Cough, sputum and/or fever
 Respiratory disease
 Dyspnea
 Severe pneumonia, pneumothorax, pleurisy, pulmo embolism
 Hemoptysis
 Carcinoma, pulmo embolism
 Shock
myocardial infarction, dissecting aneurysm (rupture ),
large area pulmo embolism
 Dysphagia (吞咽困难)


Esophageal disease
Cyanosis
 An excess of desaturated hemoglobin causes a
blue coloration of the skin or mucosae.
 methemoglobinemia (高铁血红蛋白血症）

Poisoning by nitrite (Methylthioninium Chloride iv,
亚甲兰)
Cyanosis: classification
 Central (warm)
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Deficient oxygenation
Right-to-left shunt
 Peripheral (cold)
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Reduced cardiac output
Local vasoconstriction
 Mixed
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Heart failure
Cyanosis: accompany signs
 Dyspnea

Severe cardiac or respiratory disorder
 Clubbing fingers

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Congenital heart disease
Chronic respiratory disease
 Unconsciousness

Poisoning, shock, Severe cardiac or respiratory
disorder
Dyspnea: causes
 Respiratory system

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Obstruction: asthma, COPD, tumor
Pulmo Diseases: pneumonia, interstitial lung disease,
Chest wall or pleura: pleurisy, pneumothorax, trauma
neuro-muscles: poliomyelitis ( 脊髓灰质炎), myasthenia gravis (重症肌无
力)
Diaphragma movement disorder: obviously elevated pressure in
abdominal cavity
 Cardiovascular system


Heart failure
Pulmo embolism
 Poisoning

ketoacidosis
 Central nervous system

cerebral tumor , trauma, abscess, hemorrhage, encephalitis, meningitis
 hematological system

Severe anemia
Respiratory Dyspnea
 Inspiratory dyspnea
____obstruction in large airway

Three depression sign
 depression in suprasternal fossa, supraclavicular fossa,
intercostal space
 Expiratory dyspnea
____obstruction in small airway or alveolar elasticity decreased
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Prolonged expiratory time
Expiratory rhonchi
 Mixed dyspnea
____deficient gas exchange
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Respiratory rate increased
Shallow breathing
Cardiac dyspnea ____ Heart failure
Mechanism of left heart failure

Pulmo edema

Alveolar tension increased
receptor
diffusion capacity decreased
stimulating stretch
excitation of vagus nerve
excitation of
respiratory center

Alveolar elasticity decreased

Increased pressure of pulmo circulation
respiratory center
vital capacity decreased
stimulating
Features of left heart failure
 Underlying diseases
 Mixed dyspnea
 Position related dyspnea
 Moist crackles or rhonchi in both lungs
 Relief of symptoms after digitalis, diuretic,
vasodilator agent used
Nocturnal paroxysmal dyspnea
Characteristics
 Awoken due to chest tightness or dyspnea
 Forced sitting position or orthopnea
 Severe sweat
 Tachycardia
 Moist crackles or rhonchi in both lungs
 Pink frothy sputum
Nocturnal paroxysmal dyspnea
Mechanism

Elevated excitation of vagus nerve
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Contraction of coronary artery
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Contraction of bronchiole
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Vital capacity decreased in supine position
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Returned blood volume increased
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Sensitivity of respiratory center decreased
after obvious hypoxia
myocardium ischemia
decreased alveolar ventilation
pulmo edema
reaction
Poisoning dyspnea
 Underlying diseases of metabolic acidosis
(uremia, diabetic ketoacidosis )
 deep breathing (Kussmaul breathing)
Dyspnea: accompany signs (1)
 Rhonchi
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Asthma
Acute left heart failure (cardiac asthma)
Foreign body in large airway
Acute laryngeal edema
 Chest pain
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Infection
Pneumothorax
Pulmo embolism
Lung cancer
Acute myocardial infarct
Dyspnea: accompany signs (2)
 Fever

Infection
 Cough and sputum
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COPD
Infection
Left heart failure
 Unconsciousness
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CNS disorder
Uremia
diabetic ketoacidosis