Breathlessness in Pregnancy: Cardiac Causes
Tony Hollingworth in Differential Diagnosis in Obstetrics and Gynaecology: An A-Z, 2015
Breathlessness is a common complaint in pregnancy, and is most often caused by maternal physiological changes. There are other simple, non-cardiac, causes for shortness of breath in pregnant women, such as iron deficiency anaemia and exacerbation of underlying respiratory conditions. However, shortness of breath in association with any of the following conditions should arouse suspicions of an underlying cardiac pathology: orthopnoea – breathlessness when lying flat;paroxysmal nocturnal dyspnoea – sudden onset of breathlessness at night;dysrhythmia – erratic heart rhythm;newly identified heart murmur.
History-taking model
Kaji Sritharan, Vivian A Elwell, Sachi Sivananthan in Essential OSCE Topics for Medical and Surgical Finals, 2007
Differential diagnosis of shortness of breath Cardiac disorders: mitral stenosis, left ventricular failure (LVF).Respiratory disorders: asthma, chronic obstructive pulmonary disease (COPD), chronic bronchitis, emphysema, pulmonary fibrosis, extrinsic allergic alveolitis.Anatomical disorders: diseases of the chest wall, muscles or pleura (e.g. ankylosing spondylitis, respiratory muscle paralysis, kyphoscoliosis)Other: thyrotoxicosis, ketoacidosis, pharmacological disorders (e.g. aspirin poisoning), anaemia, psychological disorders (e.g. hyperventilation, anxiety, panic disorder), physiological disorders (e.g. due to exercise and/or high altitude).
Provocation of Anxiety States in Humans and its Possible Significance for the Pathogenesis of These Disorders
Siegfried Kasper, Johan A. den Boer, J. M. Ad Sitsen in Handbook of Depression and Anxiety, 2003
Shortness of breath is one of the prominent symptoms of panic attacks. Accompanying hyperventilation leads to an increased exhalation of carbon dioxide and lowering of arterial concentration of carbon dioxide (CO2). Therefore, one would assume that increased inhalation of CO2 would decrease anxiety. Carbon dioxide did actually reduce anxiety in some studies. Griez and van den Hout [116] reported that double inhalation of a mixture of 35% CO2 and 65% oxygen reduced anxiety levels in 12 healthy volunteers. These authors also used this technique, together with exposure, in the treatment of “phobophobia” [117]. Wolpe [118] strongly advocated the use of CO2 inhalation in the treatment of anxiety.
Asthma is associated with bullying victimization in rural adolescents
Published in Journal of Asthma, 2023
April J. Ancheta, Phillippe B. Cunningham, Jianfang Liu, Jennifer S. Powell, Colleen A. Halliday, Jean-Marie Bruzzese
This study has several limitations. As with any secondary data analysis of cross-sectional data, causal inferences cannot be made. Our measurement of asthma status was limited by adolescent self-report of asthma diagnosis and symptom frequency, which is also subject to recall bias. This, coupled with our definition of asthma, may have resulted in an over estimation of the proportion of students with undiagnosed asthma. For example, shortness of breath without other asthma symptoms, may be an indication of anxiety, not asthma. Similarly, cough alone could be an indication of respiratory symptoms other than asthma. Additionally, we did not have data on medication use, which limited our ability to determine if some adolescents in the sample had well-controlled asthma. Nor did we have a measure of asthma control.
Pathophysiology and clinical evaluation of the patient with unexplained persistent dyspnea
Published in Expert Review of Respiratory Medicine, 2022
Andi Hudler, Fernando Holguin, Meghan Althoff, Anne Fuhlbrigge, Sunita Sharma
This review primarily focuses on patients in whom dyspnea is unexplained and has persisted for weeks to months, and frequently longer. Because the sensation of shortness of breath is subjective and heavily influenced by emotional, psychological, experiential, and contextual factors [1,21], it is imperative to have the patient describe what he or she means by having shortness of breath as these qualitative aspects can have diagnostic value. Breathing discomfort can be described in several ways depending on the underlying pathophysiology. For example, the sensation of increased effort or work of breathing is commonly associated with increased mechanical load, such as COPD and asthma, and in patients with neuromuscular weakness. Air hunger has been associated with stimulation of chemoreceptors by hypercapnia and/or hypoxemia with increased respiratory drive, whereas dyspnea that is associated with chest tightness more specifically indicates increased bronchial constriction [1,13].
Feasibility of a virtual service delivery model to support physical activity engagement during the COVID-19 pandemic for those with spinal cord injury
Published in The Journal of Spinal Cord Medicine, 2021
Swati Mehta, Jess Ahrens, Zeina Abu-Jurji, Stephanie L. Marrocco, Randy Upper, Eldon Loh, Stephanie Cornell, Dalton L. Wolfe
Shortness of breath and pain were adverse events reported by participants. Shortness of breath was reported by one participant after the exercise class for weeks 1 –4. During the first exercise class, shortness of breath impacted this participant by causing her to “need to take a small couple seconds to catch up”. Similarly, this participant was “challenged to keep up” during the second week of exercise classes. During the third week of exercise courses, this participant only experienced shortness of breath during “the beginning while blood pressure catches up” and during the fourth week, found herself to be “challenged at times when using 1 lb weights”. The onset of pain was reported by two participants after the first week of exercise; neuropathic foot pain and shoulder tightness/ upper back knots. Shoulder pain was also reported by one participant after week five; however, it was specified that the pain was not due to the exercise class. The same participant who reported experiencing shortness of breath and shoulder pain also reported positive changes in her ability to perform activities of daily living after weeks 3 - 6 of the exercise classes. After weeks 3 through 5, she reported benefits of it being easier to wheel up hills and slopes and after week 6, she reported having improved strength.
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