BSN Notes: Common Signs And Symptoms: Dyspnea

Dyspnea -  difficulty in breathing

Mechanisms of Dyspnea

·         Respiratory sensations are the consequence of efferent and afferent input from receptors throughout the body.

·         A given disease state may lead to dyspnea by one or more mechanisms.

            Motor Efferents:

·         Disorders of the ventilatory pump are associated with increased work of breathing or a sense of an increased effort to breathe.

·         When the muscles are weak or fatigued, greater effort is required, even though the mechanics of the system are normal.

            Sensory Afferents:

·         Chemoreceptors in the carotid bodies and medulla are activated by hypoxemia, acute hypercapnia, and academia.

·         Leads to increase in ventilation, produce a sensation of air hunger.

Occurs in -

·         Chest tightness or constriction -  in Bronchoconstriction, asthma, myocardial ischemia

·         Increased work or effort of breathing - Airway obstruction, neuromuscular disease, kyphoscoliosis

·         Air hunger, need to breathe- Increased drive to breathe (CHF, pulmonary embolism, moderate to severe airflow obstruction.

Common causes

Respiratory System Dyspnea

·         Disorders of the airways (e.g., asthma, emphysema, chronic bronchitis, and bronchiectasis) lead to increased airway resistance and work of breathing. Hyperinflation further increases the work of breathing

·         Conditions that stiffen the chest wall, such as kyphoscoliosis, or that weaken ventilatory muscles, such as myasthenia gravis or the Guillain-Barre syndrome, are also associated with an increased effort to breathe.

·         Pneumonia, pulmonary edema, and aspiration all interfere with gas exchange.

·         Pulmonary vascular and interstitial lung disease and pulmonary vascular congestion may produce dyspnea by direct stimulation of pulmonary receptors.

Cardiovascular System Dyspnea

·         Mild to moderate anemia is associated with breathing discomfort during exercise

·         Hypertension, aortic stenosis, or hypertrophic cardiomyopathy- cause of exercise-induced breathlessness.  

·         Pericardial disease.

·         Diseases of the myocardium resulting from coronary artery disease and non-ischemic cardiomyopathies.

Management

·         Correct the underlying problem responsible for the symptom.  

·         Supplemental O2 administration -  oxygen mask , venture mask  

·         Propped up position.

·         Intubation and mechanical ventilation.

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