Aisha is not feeling so good

Aisha is not feeling so good

1. Shortness of breath - Dyspnea

   • Definition : An intense tightening in the chest, air hunger or a feeling of suffocation.
   • Normally arises when :
     • Very strenuous exercise
     • Extreme temperatures
     • Massive obesity
     • High altitude
   • Pathological causes
     • Acute
       • CO poisoning
       • Hypotension
       • Pulmonary embolism
       • Cardiac tamponade
       • Heart failure
       • Pneumothorax
       • Pneumonia
       • Hemorrhage
     • Chronic
       • Asthma
       • COPD
       • Heart dysfunction
       • Interstitial lung disease
       • Renal impairment
       • Obesity
   • Types
     • Orthopnea
       • Sensation of breathlessness in the recumbent position, relieved by sitting or standing
       • Patient will increase the number of pillows at night to avoid becoming dyspnoeic due to the accumulation of fluid & edema
         • Edema
           • What is edema?
             • The accumulation of fluid in the interstitial space.
           • Types
             • Transudate :Filtration (starling forces).
             • Exudate: increase in vascular permeability.
           • Causes of edema
     • Paroxysmal nocturnal Dyspnea
       • Sensation of shortness of breath that awakens the patient, often after 1 or 2 hours of sleep.

2. Heart Failure

   • Lifestyle risk factors
     • Smoking
     • Diabetes
     • Hypertension
     • Hyperlipidemia
   • Types of heart failure
     • Left sided heart failure
       • Heart failur with reduced ejection fraction: The left venticle loses ability to contract, the heart loses ability to contract normally.
       • Heart failure with preserved ejection fraction: The left venticle loses its ability to properly fill with blood thus the heart does not pump enough blood into the circulation.
     • Right sided heart failure
       • Usually occurs With association of left sided heart hailure.
     • Congestive heart failure
       • Covers and used interchangebly with LHF & RHF
   • Prognosis
     • Poor prognosis
   • History taking
   • Physical examination
     • General Inspection (signs of shortness of breath)
     • Blood pressure measurement (High- 168/102)
     • Hands: Tar stain, peripheral cyanosis.
     • Assessment of pulse: Rate (tachycardia- 95), rhythm (irregular), character (pulsus alternans),
     • Face : Mitral facies, xanthelasmata
     • Eyes: Icterus/ jaundice
     • Mouth: central cyanosis
     • Lower limbs: Pitting edema
     • Auscultation: S3 & S4.
     • The back:: Percuss (dull), auscultate (crackles, wheezing).
     • Neck : elevated JVP = High arterial pressure, Hepatojugular reflex (higher level > few seconds).
   • Investigations
     • Chest X-ray findings
       • Congestion in the upper lobes
       • Perihilar congestion
       • Fluffy alveolar infiltrates
       • Kerley lines
       • Air bronchograms
     • ECG
     • Echocardiogram
   • Treatment
     • Frusemide
       • Loop diuretics that act on the Na+-K+-2Cl− symporter (cotransporter) in the thick ascending limb of the loop of Henle to inhibit sodium, chloride and potassium reabsorption.
     • Common Side effects
       • Vomiting, diarrhea, fever, chills, or nausea.
       • Muscle pain, cramps, or weakness.
       • Irregular heartbeat.
       • Ototoxicity
       • Headache
     • Enalapril
       • After hydrolysis to enalaprilat, inhibits angiotensin-converting enzyme (ACE) a peptidyl dipeptidase that catalyzes the conversion of angiotensin I to the vasoconstrictor substance, angiotensin II.
     • Carvedolil
       • Carvedilol is used to prevent further worsening of congestive heart failure. It is also used to treat left ventricular dysfunction after a heart attack.

3. Transtheoretical model

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