Stuffiness
Shortness of breath (dyspnoea) is a very common subjective symptom of many diseases. The patient describes it either as a feeling of lack of air or difficult and labored breathing.
Shortness of breath is a subjective feeling of lack of air.
Causes[edit | edit source]
We divide the causes of shortness of breath based on the primary organ involvement into:
- 'pulmonary - COPD, asthma, inflammatory lung diseases (pneumonia), interstitial lung processes (pneumonitis, pulmonary fibrosis due to pneumoconiosis or other diseases)
- pulmonary circulation disease with the development of pulmonary arterial hypertension (primary pulmonary hypertension or a consequence of pulmonary embolism),
- cardiac - heart failure with congestion in the pulmonary circulation and the development of pulmonary edema - left-sided heart failure, or mitral stenosis ( processes associated with an increase in left atrial pressure),
- psychogenic - hysteria, hyperventilatory tetany,
- neuromuscular - neurodegenerative muscle diseases, myasthenia, trauma,
- hematological - anemia
- metabolic longer lasting respiratory compensation (Kussmaul respiration in decompensation diabetic ketoacidosis)
Types[edit | edit source]
To assess shortness of breath, it is very important to distinguish whether it is "exertion" or "rest". Dyspnea at rest usually indicates a greater degree of impairment. We also distinguish between inspiratory (difficult inhalation, e.g. in pneumonia) and expiratory (difficult, usually slow exhalation, e.g. in asthma). Depending on the nature and development of the problem, we can distinguish several different types of shortness of breath.
| Sudden shortness of breath | Shortness of breath developed over hours, days |
|---|---|
| pneumothorax | COPD exacerbation, asthma bronchiale, fibrosis (IPF) |
| foreign body aspiration | left heart failure |
| pulmonary embolism | pneumonia, pleural effusion |
Rapidly progressive shortness of breath (acute shortness of breath)[edit | edit source]
This form of shortness of breath can occur suddenly, e.g. after aspiration (of a foreign body, stomach contents), or after trauma (formation of pneumothorax). In the same way, among acute shortness of breath, we classify problems that develop in the order of days. These can be a symptom of severe pulmonary embolism, massive pulmonary edema (e.g. acute mountain sickness) and, last but not least, acute coronary syndrome (acute myocardial infarction, unstable angina pectoris), exacerbation of asthma.
| Differential diagnosis of acute dyspnea [1] | ||
|---|---|---|
| symptoms | likely cause of shortness of breath | |
| shortness of breath and chest pain | ACS, PE, aortic dissection, pneumothorax, pleuritis | |
| prolonged expiration, cough | left-sided heart failure, asthma bronchiale, exacerbation of COPD | |
| stridor | HCD obstruction, foreign body aspiration | |
| cough and fever | pneumonia, acute bronchitis | |
| cough without febrile | pneumothorax, foreign body aspiration | |
| silent lungs, rare spastic phenomena | status asthmaticus | |
| general condition without alteration, paresthesia of limbs | hyperventilation | |
| shortness of breath without pathological on the lungs | anemia, PE, pulmonary hypertension, intoxication, psychogenic dyspnea, ascites, metabolic acidosis, diabetic coma, uremia, musculoskeletal etiol. eg:Guillan-Barré syndrome, Myasthenia gravis | |
Long-term slowly progressive shortness of breath (chronic shortness of breath)[edit | edit source]
It is typical for COPD, chronic pulmonary fibrotic processes and heart failure. The patient describes long-term problems, which gradually worsen, especially in relation to strenuous activities.
Orthopnoic dyspnea[edit | edit source]
In case of orthopnoic dyspnea, the so-called ortopnoic position will help the patient. Sitting with a slight forward bend will cause a reduction in venous return and allow more efficient use of the accessory respiratory muscles, thereby improving the overall mechanics of ventilation.
Paroxysmal nocturnal dyspnea[edit | edit source]
It typically appears in cardiac patients, the so-called cardiac asthma, and can accompany the initial phase of left ventricular failure. The patient wakes up at night with an urge to sit up, reports "impossibility to inhale", shortness of breath and a feeling of "exhaled air in the room".
NYHA dyspnoea classification[edit | edit source]
NYHA (N'ew York Heart Association) dyspnea classification is currently the most widely used. It is primarily intended for the classification of dyspnea in heart failure, but is also commonly used to assess dyspnea of other etiologies.
| NYHA Classification of Dyspnea[2] | ||
|---|---|---|
| Class Definition | Limitation of activity | |
| NYHA I | It can't handle only higher effort, faster running. | It does not limit in everyday life. |
| NYHA II | He can walk as fast as possible, but not run. | Fewer restrictions in everyday life. |
| NYHA III | Only basic household activities, walking 4 km/h. Normal activity is already exhausting. | Significant limitation of activity at home. |
| NYHA IV | Shortness of breath with minimal exertion and at rest. Necessary help from another person. | Fundamental limitations in life. |
Links[edit | edit source]
Related Articles[edit | edit source]
References[edit | edit source]
References[edit | edit source]
- CZECH, Richard. Intern. 1. edition. Prague : Triton, 2010. 855 pp. pp. 19-20. ISBN 978-80-7387-423-0.
- KLENER, Paul. Propedeutics in internal medicine. 3rd revised edition edition. Prague : Galen, 2009. 324 pp. pp. 26. ISBN 978-80-7262-643-4.
- BEETLE, Ladislav. Propedeutics of internal medicine. 2. edition. Prague : GRADA Publishing, 2007. pp. 243. ISBN 978-80-247-1309-0.
