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Cardiopulmonary Acute disease
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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 !?