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Difficulty breathing
This is a mind map about dyspnea, including causes, definitions, mechanisms, clinical manifestations, accompanying symptoms, etc. Hope this helps!
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Difficulty breathing
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- Outline
Difficulty breathing
Definition
It refers to the patient's subjective feeling of lack of air and labored breathing. Objectively, when the respiratory exertion is severe, mouth breathing, nose flaring, orthopnea, and even cyanosis may occur. The respiratory accessory muscles participate in the respiratory movement, and there is a change in the respiratory frequency rhythm
Cause
Respiratory diseases
Airway obstruction
Inflammation, edema, tumors or foreign bodies of the larynx, trachea, and bronchi causing stenosis or obstruction and bronchial asthma
Lung disease
Pneumonia, lung abscess, tuberculosis, atelectasis, pulmonary congestion, pulmonary edema
Chest wall, thoracic cage, pleural space diseases
Pleural effusion, pneumothorax, extensive pleural adhesions, tuberculosis
Neuromuscular diseases
Poliomyelitis lesions affect the cervical spinal cord, myasthenia gravis affects respiratory muscles, and drugs cause respiratory muscle paralysis, etc.
Diaphragmatic dyskinesia
Diaphragmatic paralysis, massive peritoneal effusion, giant abdominal tumor, gastric dilation and late pregnancy
Circulatory system diseases
Left and right heart failure, cardiac tamponade (pericardial effusion, obstruction of superior and inferior vena cava return) and primary pulmonary hypertension
poisoning
Diabetic ketoacidosis, morphine drug poisoning, organophosphate drug poisoning, nitrite and acute carbon monoxide poisoning
Neuropsychiatric disorders
Cerebral hemorrhage, respiratory center dysfunction caused by brain trauma and dyspnea caused by mental factors, such as anxiety, hysteria, etc.
Blood diseases
Common in severe anemia, methemoglobinemia, sulfhemoglobinemia, etc.
Mechanism and clinical manifestation
Pulmonary dyspnea
Inspiratory dyspnea
Caused by airway obstruction, in severe cases, three concavities can be seen when inhaling, that is, the suprasternal fossa, supraclavicular fossa, and intercostal space are obviously depressed. It is mainly caused by the extreme exertion of the respiratory muscles and the increase of negative pressure in the chest. This may also be accompanied by dry cough and high-pitched inspiratory laryngitis.
Commonly seen in stenosis and obstruction of the larynx, trachea, and large bronchi
expiratory dyspnea
It manifests as effortful expiration, slow expiration, significantly prolonged breathing time, and is often accompanied by wheezing during expiration
Mainly caused by weakened alveolar elasticity and spasm or inflammation of small bronchi
Common in chronic bronchitis, chronic obstructive pulmonary disease, bronchial asthma
Mixed dyspnea
Symptoms include labored breathing during both the inspiratory and expiratory phases, increased respiratory frequency, shallower depth, and abnormal breath sounds
It is mainly caused by lung or chest lesions that reduce the breathing area, leading to ventilation dysfunction
Common in severe pneumonia, severe pulmonary tuberculosis, massive pulmonary embolism, large pleural effusion and pneumothorax
Cardiogenic dyspnea
Left heart failure
Features
There are underlying causes of left heart failure, such as rheumatic valvular heart disease, hypertensive heart disease, coronary heart disease, etc.
It is often mixed dyspnea. Dyspnea during activity is aggravated or disappears when resting. It is obvious when lying down and is relieved when sitting or standing. Therefore, when the condition is serious, use semi-sitting or orthopnea.
Rales appear at the base of both lungs or throughout the lungs
After applying cardiotonic agents, diuretics and vasodilators to improve left ventricular function, dyspnea symptoms improved
mechanism
Pulmonary blood stasis reduces gas diffusion function
Alveolar tension increases, stimulating stretch receptors and exciting the respiratory center through vagal reflex
When alveolar elasticity decreases, vital capacity decreases
Increased pulmonary circulation pressure, reflex stimulation of respiratory center
Performance
Acute left heart failure may cause paroxysmal nocturnal dyspnea, which manifests as sudden chest tightness during sleep at night and being forced to sit up. In mild cases, the symptoms are relieved within tens of minutes. In severe cases, symptoms may be seen in orthopnea, cyanosis, profuse sweating, and coughing up serous fluid. Sexually pink frothy sputum, rapid heart rate and galloping rhythm
Right heart failure
It is lighter than the dyspnea caused by left heart failure and is mainly caused by blood stasis in the systemic circulation
Clinically seen in chronic pulmonary heart disease, some congenital heart diseases or left heart failure.
mechanism
The pressure in the right atrium and superior vena cava increases, stimulating baroreceptors and reflexively exciting the respiratory center
The blood oxygen content decreases and the metabolites of lactic acid and pyruvate increase, leading to acidosis and irritating the respiratory center
Stasis hepatomegaly, abdominal effusion and pleural effusion limit respiratory movement and reduce the lung gas exchange area
Toxic dyspnea
Metabolic acidosis
The acidic metabolites in the blood increase, stimulating the carotid sinus and aorta body chemoreceptors or directly stimulating the respiratory center, causing dyspnea
Features
There are underlying diseases that cause metabolic acidosis, such as uremia and diabetic ketosis
Deep, long and regular breathing occurs, and deep breathing is caused by acidosis
drug poisoning
When poisoned by central depressant drugs such as morphine and barbiturates and organophosphate drugs, they inhibit the respiratory center and cause dyspnea
Features
Have a history of drug poisoning
Slow breathing accompanied by changes in respiratory rhythm, such as tidal breathing or paused breathing
Chemical poisoning
Commonly seen in carbon monoxide poisoning and cyanide poisoning, which starve the body of oxygen and cause difficulty breathing
Mechanism
During carbon monoxide poisoning, the inhaled carbon monoxide combines with hemoglobin to form carboxyhemoglobin, which loses its ability to carry oxygen, leading to hypoxia and dyspnea.
When nitrite and aniline are poisoned, hemoglobin changes to methemoglobin and loses its ability to carry oxygen, leading to hypoxia
During cyanide poisoning, cyanide ions inhibit the activity of cytochrome oxidase, affect cell respiration, cause tissue hypoxia, cause breathing difficulties, and in severe cases, cause cerebral edema and inhibit the respiratory center
Neuropsychiatric dyspnea
Neurogenic dyspnea
Because the respiratory center is stimulated by increased intracranial pressure and reduced blood supply, breathing becomes slow and deep, often accompanied by changes in respiratory rhythm, such as double inhalation (sobbing-like breathing), respiratory arrest (sudden cessation of breathing). Commonly seen in severe craniocerebral diseases, cerebral hemorrhage, brain abscess, brain tumors, etc.
Psychogenic dyspnea
It manifests as fast and shallow breathing, accompanied by sighing breathing or tetany of the hands and feet. Clinically, it is common in anxiety disorder and hysteria. Patients may have sudden difficulty breathing
Hematogenous dyspnea
It is often caused by the red blood cells carrying oxygen, which reduces blood oxygen content and decreases
Manifested as shallow breathing and rapid heart rate
Common in severe anemia, methemoglobinemia, sulfhemoglobinemia, etc.
Accompanying symptoms
Paroxysmal dyspnea with wheezing
Commonly seen in bronchial asthma, cardiac asthma, sudden severe dyspnea, acute laryngeal edema, and foreign bodies in the trachea
With fever
Seen in pneumonia, lung abscess, tuberculosis
With chest pain on one side
Seen in lobar pneumonia, pulmonary embolism, spontaneous pneumothorax, acute myocardial infarction
Cough and expectoration
Given COPD, pneumonia, bronchiectasis, lung abscess
A large amount of foamy sputum is seen in organophosphorus poisoning Pink frothy sputum is seen in acute left heart failure
With impaired consciousness
Seen in cerebral hemorrhage, meningitis, diabetic ketoacidosis, pulmonary encephalopathy (difficulty breathing first, then coma)
Fainting first and then having difficulty breathing is due to poisoning or cerebrovascular disease