Dyspnea 總論

Defination of dyspnea, type of dyspnea

名詞辨別
• Dyspnea 呼吸困難
• shortness of breath
• sensation of difficult or uncomfortable breathing
• 病人主觀感受

• Tachypnea 呼吸急促
• rapid breathing
• increase in the respiratory rate above normal (Adults: 20 breaths/min)
• 無關病人主觀感受
Types of dyspnea
• Dyspnea on exertion (DOE) 活動性呼吸困難
• occurs at a level of activity that is usually well tolerated
• 呼吸或循環問題都可能造成 chronic dyspnea 常見原因
• Respiratory: asthma, acute exacerbation of COPD, pneumonia, pulmonary embolism,
lung malignancy, pneumothorax, or aspiration, interstitial lung disease
• Cardiovascular: congestive heart failure (most common!), pulmonary edema, acute
coronary syndrome, pericardial tamponade, valvular heart defect, pulmonary
hypertension, cardiac arrhythmia, or intracardiac shunting
• systemic illnesses: anemia, acute renal failure, metabolic acidosis, thyrotoxicosis,
cirrhosis of the liver, anaphylaxis, sepsis, angioedema, and epiglottitis, obesity, or
deconditioning
Types of dyspnea(left ventricular failure)
• Orthopnea 端坐呼吸
• recumbent 躺 position
• Relieved: sitting or standing
• left ventricular failure

• Paroxysmal nocturnal dyspnea (PND) 陣發性夜間呼吸困難

• awakens the patient
• often after 1 or 2 hours of sleep
• relieved: upright position
• left ventricular failure
Types of dyspnea (uncommon)
• Trepopnea 轉臥呼吸
• one lateral decubitus 臥 position as opposed to the other
• asymmetric lung disease, heart disease

• Platypnea 斜臥呼吸
• upright position
• Relieved: recumbency.
• COPD, congenital heart disease
Dyspnea on exertion
History, physical exam
History （本次教案中有的）
• Cough: asthma, COPD, or pneumonia
• Tobacco use: COPD, congestive heart failure, and pulmonary
embolism
• Fever: infectious etiology
• Hemoptysis: lung cancer, pulmonary embolism, bronchiectasis,
chronic bronchitis, tuberculosis
History （本次教案中無，參考）
• severe sore throat: epiglottitis
• Pleuritic quality chest pain: pericarditis, pulmonary embolism,
pneumothorax, or pneumonia
• Orthopnea, nocturnal paroxysmal dyspnea, and edema: congestive
heart failure
• Indigestion 消化不良 or dysphagia 吞嚥困難 : gastroesophageal
reflux disease or gastric secretion aspiration in the lungs
Physical exam
• severity of dyspnea
• Distention of the neck veins: cor pulmonale caused by severe COPD,
congestive heart failure, or cardiac tamponade
• Thyromegaly: hyperthyroidism or hypothyroidism
Physical exam
• Lung auscultation
• Wheezing: asthma, COPD, (pulmonary edema, pulmonary embolism)
• Rales: pulmonary edema, pneumonia
• Heart auscultation
• S3 gallop: cardiac overfilling seen in left ventricular systolic dysfunction and
congestive heart failure (CHF)
• S4 gallop: left ventricular dysmotility and dysfunction
• loud P2: pulmonary hypertension
• Murmurs: valvular dysfunction
• Diminished heart sounds: cardiac tamponade
• Rubbing cardiac sound: pericarditis
Physical exam
• abdominal examination
• hepatomegaly, ascites, positive hepatojugular reflux: CHF
• 四肢
• Lower extremity edema: CHF
• extreme swelling of the extremities: deep venous thrombosis→pulmonary
embolism
• Digits clubbing: lung malignancy or severe chronic hypoxia
• Cyanosis of the extremities: hypoxia
Pneumonia
• typical accompanying symptoms
• pleuritic pain
• Fever
• cough
• Examination
• Tachypnea
• inspiratory rales
• sometimes bronchial breathing
• Diagnosis
• Lab: inflammatory parameters; hypoxemia in arterial blood gas analysis
• chest x-ray, chest CT
reference
• Mukerji V. Dyspnea, Orthopnea, and Paroxysmal Nocturnal Dyspnea. In: Walker HK, Hall WD, Hurst JW,
editors. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. Boston:
Butterworths; 1990. Chapter 11. Available from: https://www.ncbi.nlm.nih.gov/books/NBK213/
• Bass JB JR.. Dyspnea. In: Walker HK, Hall WD, Hurst JW, editors. Clinical Methods: The History, Physical, and
Laboratory Examinations. 3rd edition. Boston: Butterworths; 1990. Chapter 36. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK357/
• Sharma S, Badireddy M. Dyspnea on Exertion (DOE) [Updated 2019 Jan 20]. In: StatPearls [Internet]. Treasure
Island (FL): StatPearls Publishing; 2018 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK499847/
• Berliner D, Schneider N, Welte T, Bauersachs J. The Differential Diagnosis of Dyspnea. Dtsch Arztebl Int.
2016;113(49):834-845.