Case 4.2Fatima AlAwadh

Fatima AlMohammed Saleh

Objectives

List the causes of shortness of breath. State chest x-ray indications (uses). Describe breathing pattern assessment. Define vesicular & whistling breathing sounds. Define Crepitus & mention its causes. Enumerate the indications of Visible jugular veins,

nitroglycerin, and continuous murmur of the apex. Discriminate the differential diagnosis. Explain the papillary muscle rupture. Define and relate cardiac asthma and COPD with our

case.

Introduction

Cardiopulmonary disease is disease which involves both the heart and lungs.

It may be known as heart-lung disease. It can take a number of forms. Left untreated, cardiopulmonary disease can

be deadly.

Shortness of Breath Defined as uncomfortable breathing.

Etiology of SOB :

Pulmonary• pneumonia, tuberculosis or chronic Asthma,

chronic obstructive lung disease (COPD), emphysema, pulmonary embolism, pneumothorax.

Cardiac• Heart Failure.

Systemic Illness Problems• Anemia, and Increased metabolic states.

Indications of Chest X-Ray

Diagnostic• Pathology of the skeletal system as well

as for some soft tissue diseases.

Progressive

• To asses progression of a condition or effectiveness of treatment.

• To check the position of implanted pacemaker wires and other internal devices

• To check status of lungs and chest cavity after surgery.

Diagnostic Chest X-ray

Rib Fracture Lung Problems Cardiovascular problems

• Lung cancer.• COPD.• Pleuritis.• Pneumonia.• Pneumothorax.• Pulmonary

edema

• Cardiomegaly.• Congenital heart

diseases.• Heart failure.• Pericardial effusion. • Valvular heart

diseases.• Calcification of the

heart structures.

Respiratory Examination

RESPIRATORY ASSESSMENT CONSISTS OF FOUR COMPONENTS

1 .Inspection

2 .Palpation

3 .Percussion

4 .Auscultation

Inspection

Inspection involves using your eyes and ears to assess a variety of things regarding the patient.

With the patient sitting, examine the patient's anterior and posterior chest for the following

General Appearance; Color, Ability to speak, & Respiratory effort.

Skin Color; especially Around mouth/lips & Nail beds.

Chest Wall Abnormalities; as Scoliosis & kyphosis.

Noisy Breathing.

Pursed Lip Breathing.

Coughing.

Respiratory Rate & Pattern.

Palpation

An assessment technique in which the examiner uses the surface of the fingers and hands to feel for abnormalities.

Assessment data that canbe obtained through palpation includes: identifying chest movement

symmetry. chest skeletal abnormalities. Tenderness. skin temperature changes. Swelling & masses.

Percussion

Types of percussion notes: Flat (over bone) Dull (muscle & soft

tissue) Resonant (normal lung) Hyper-resonant

(Emphysema) Tympanic (free air)

Auscultation

During auscultation Patient should be upright

taking deep breaths through the mouth.

Eliminate outside noise if Possible.

Auscultation

Vesicular breathing sound

Vesicular sounds are soft, or rustling sounds normally heard throughout most of the lung fields.

Vesicular sounds are normally heard throughout inspiration, continue without pause through expiration.

Medium pitch & loudness. Inspiration louder.

Whistling

Abnormal, high pitched breath sounds.

Heard in the airways. Caused by air being

forced through narrowed passageways by secretions or another mechanical or functional obstruction.

Crepitus

Is crackling chest sound heard in pneumonia and other lung diseases.

Caused by fluid in the small airways.

The popping sounds produced are created when air is forced through narrowed respiratory passages by fluid.

Crepitus Etiology

Crackles are often associated with inflammation or infection of the small bronchi, bronchioles, and alveoli.

Crackles may indicate pulmonary edema or fluid in the alveoli due to heart failure or adult respiratory distress syndrome (ARDS).

Differential Diagnosis

Left sided heart failure

Mitral valve regurgitatio

n

Papillary muscle

dysfunction

Pulmonary Edema

Papillary muscle

Papillary muscles are small finger like structures that arise from the wall of the ventricles and are attached to the leaflets of atrioventricular valves.

Papillary muscle rupture

The entire muscle may

become detached from the ventricular

wall.

The mitral valve will no longer

function effectively

because of this sudden

incompetence.

As a result blood will flow

backwards into the lung, and

they will fill with fluid causing

acute pulmonary edema.

Chronic Obstructive Pulmonary Disease COPD is a partially reversible airflow

limitation caused by an inflammatory response to inhaled toxins, after cigarette smoke.

Symptoms are productive cough and dyspnea that develop over years.

Common signs include decreased breath sounds, prolonged expiratory phase, and wheezing.

Diagnosis is based on history, physical examination, chest x-ray, and pulmonary function tests.

Cardiac Asthma

A medical symptom, of wheezing, coughing or shortness of breath.

It is known as cardiac asthma because the symptoms may mimic asthma.

As a result of heart failure, fluid can build up in the lungs (pulmonary edema) and in and around airways.

Nitroglycerin

A thick, pale yellow liquid.

Used as a vasodilator in medicine.

The drug should not be used continuously, because tolerance develops within 24 to 48 hrs.

 It is prescribed for :

The prevention or relief of angina pectoris.

Treating pulmonary hypertension,

Helping to treat congestive heart failure

following acute myocardial infarction

And treating hypertensive emergencies during

cardiovascular surgery.

Any Questions !?