Bronchial asthma. General examination of cardiac patients How human breathing occurs

Dyspnea is a breathing disorder that is accompanied by a change in its frequency and depth. As a rule, breathing during shortness of breath is rapid and shallow, which is a compensatory mechanism ( adaptation of the body) in response to lack of oxygen. Dyspnea that occurs during inhalation is called inspiratory, and shortness of breath during exhalation is called expiratory. It can also be mixed, that is, occur both on inhalation and exhalation. Subjectively, shortness of breath is felt as a lack of air, a feeling of compression of the chest. Normally, shortness of breath may appear in a healthy person, in which case it is called physiological.

Physiological shortness of breath may appear in the following cases:

• as the body’s reaction to excessive physical activity, especially if the body is not constantly exposed to physical activity;
• at high altitudes, where hypoxic conditions are created ( lack of oxygen);
• in confined spaces with an increased number of carbon dioxide (hypercapnia).

Depending on the etiology(reasons for occurrence)shortness of breath can be of the following types:

• cardiac dyspnea;
• pulmonary shortness of breath;
• shortness of breath as a consequence of anemia.

Doctors to contact if you experience shortness of breath include:

• therapist;
• family doctor;
• cardiologist;
• pulmonologist

How does human breathing occur?

The respiratory system consists of the following organs:

• nasal and oral cavity;
• larynx;
• trachea;
• bronchi;
• lungs.

Atmospheric air enters the lungs through the airways and further into the pulmonary alveoli. Gas exchange occurs in the alveoli, that is, carbon dioxide is released, and the blood is saturated with oxygen. Next, oxygenated blood is sent to the heart through the pulmonary veins, which drain into the left atrium. From the left atrium, blood flows into the left ventricle, from where it goes through the aorta to organs and tissues. Caliber ( size) arteries, through which blood is carried throughout the body, moving away from the heart, gradually decreases to capillaries, through the membrane of which gases are exchanged with tissues.

The act of breathing consists of two stages:

• Inhale, in which atmospheric air saturated with oxygen enters the body. Inhalation is an active process that involves the respiratory muscles.
• Exhalation, in which air saturated with carbon dioxide is released. When you exhale, the respiratory muscles relax.

Cardiac dyspnea

Causes of cardiac dyspnea

The most common causes of cardiac dyspnea include:

• heart failure;
• acute coronary syndrome;
• hemopericardium, cardiac tamponade.

In most cases, heart failure develops under such pathological conditions as:

• arterial hypertension;
• IHD ( cardiac ischemia);
• constrictive pericarditis ( inflammation of the pericardium, accompanied by its hardening and impaired heart contraction);
• restrictive cardiomyopathy ( inflammation of the heart muscle with decreased compliance);
• pulmonary hypertension ( increased blood pressure in the pulmonary artery);
• bradycardia ( decrease in heart rate) or tachycardia ( increased heart rate) of various etiologies;
• heart defects.

In the early stages of heart failure, shortness of breath may be absent. Further, as the pathology progresses, shortness of breath appears when heavy loads, under light loads and even at rest.

Symptoms of heart failure associated with shortness of breath are:

• cyanosis ( bluish discoloration of the skin);
• cough, especially at night;
• hemoptysis ( hemoptysis) – expectoration of sputum mixed with blood;
• orthopnea – rapid breathing in a horizontal position;
• nocturia – increased urine formation at night;

Symptoms of acute coronary syndrome are considered to be:

• pain behind the sternum, which can also radiate to the left shoulder, left arm, lower jaw; as a rule, the pain lasts more than 10 minutes;
• shortness of breath, feeling of lack of air;
• feeling of heaviness behind the sternum;
• paleness of the skin;

First aid for symptoms of acute coronary syndrome is sublingual nitroglycerin ( under the tongue), unbuttoning tight clothing that is squeezing the chest, providing fresh air and calling an ambulance.

Heart defects
A heart defect is a pathological change in the structures of the heart that leads to impaired blood flow. Blood flow is disrupted in both the systemic and pulmonary circulation. Heart defects can be congenital or acquired. They may concern the following structures - valves, septa, vessels, walls. Congenital heart defects appear as a consequence of various genetic abnormalities and intrauterine infections. Acquired heart defects can occur against the background of infective endocarditis ( inflammation of the inner lining of the heart), rheumatism, syphilis.

Heart defects include the following pathologies:

• ventricular septal defect– this is an acquired heart defect, which is characterized by the presence of a defect in certain parts of the interventricular septum, which is located between the right and left ventricles of the heart;
• patent oval window– a defect in the interatrial septum that occurs due to failure to close oval window, which is involved in the blood circulation of the fetus;
• open arterial ( botalls) duct, which in the prenatal period connects the aorta to the pulmonary artery, and must close during the first day of life;
• coarctation of the aorta– heart disease, which manifests itself as a narrowing of the aortic lumen and requires cardiac surgery;
• heart valve insufficiency– this is a type of heart defect in which complete closure of the heart valves is impossible and reverse flow of blood occurs;
• heart valve stenosis characterized by narrowing or fusion of the valve leaflets and disruption of normal blood flow.

The most common symptoms of heart defects are:

• dyspnea;
• cyanosis of the skin;
• pale skin;
• loss of consciousness;
• retardation in physical development;

Heart defects are diseases that can be alleviated with the help of therapeutic methods, however, it can only be completely cured through surgery.

Cardiomyopathy
Cardiomyopathy is a disease characterized by damage to the heart and manifests itself as hypertrophy ( increase in the volume of cardiac muscle cells) or dilatation ( increase in the volume of the heart chambers).

There are two types of cardiomyopathies:

• primary (idiopathic), the cause of which is unknown, but it is assumed that these may be autoimmune disorders, infectious factors ( viruses), genetic and other factors;
• secondary, which appears against the background of various diseases ( hypertension, intoxication, coronary heart disease, amyloidosis and other diseases).

The most common manifestations of cardiomyopathy are considered to be:

• shortness of breath;
• cough;
• pale skin;
• increased fatigue;
• increased heart rate;
• dizziness.

Myocarditis
Myocarditis is damage to the myocardium ( heart muscle) predominantly inflammatory in nature. Symptoms of myocarditis are shortness of breath, chest pain, dizziness, and weakness.

Among the causes of myocarditis are:

• Bacterial and viral infections more often than other causes cause infectious myocarditis. The most common causative agents of the disease are viruses, namely the Coxsackie virus, measles virus, and rubella virus.
• Rheumatism, in which myocarditis is one of the main manifestations.
• Systemic diseases such as systemic lupus erythematosus, vasculitis ( inflammation of the walls of blood vessels) lead to myocardial damage.
• Taking certain medications ( antibiotics), vaccines, serums can also lead to myocarditis.

Pericarditis
Pericarditis – inflammatory lesion pericardium ( pericardial sac). The causes of pericarditis are similar to the causes of myocarditis. Pericarditis manifests itself as prolonged pain in the chest (which, unlike acute coronary syndrome, do not improve with nitroglycerin), fever, severe shortness of breath. With pericarditis, due to inflammatory changes in the pericardial cavity, adhesions can form, which can then grow together, which significantly complicates the functioning of the heart.

With pericarditis, shortness of breath often occurs in a horizontal position. Shortness of breath with pericarditis is a constant symptom and it does not disappear until the cause is eliminated.

Cardiac tamponade
Cardiac tamponade is a pathological condition in which fluid accumulates in the pericardial cavity and hemodynamics are disrupted ( movement of blood through vessels). The fluid that is in the pericardial cavity compresses the heart and limits heart contractions.

Cardiac tamponade can appear as acutely ( for injuries), and for chronic diseases ( pericarditis). It manifests itself as painful shortness of breath, tachycardia, and decreased blood pressure. Cardiac tamponade can cause acute heart failure and shock. This pathology is very dangerous and can lead to complete cessation of cardiac activity. Therefore, timely medical intervention is of utmost importance. As an emergency, pericardial puncture and removal of pathological fluid are performed.

Diagnosis of cardiac dyspnea

The following methods are used to diagnose shortness of breath:

• physical examination ( conversation with the patient, examination, palpation, percussion, auscultation);
• ultrasonography ( transesophageal, transthoracic);
• X-ray examination of the chest organs;
• CT ( CT scan);
• MRI ( );
• ECG ( electrocardiography), ECG monitoring;
• cardiac catheterization;
• bicycle ergometry.

When collecting anamnesis, you need to pay attention to the following information:

• Characteristics of shortness of breath, which can be on inspiration, on expiration or mixed.
• The intensity of shortness of breath may also indicate a certain pathological condition.
• Hereditary factor. The likelihood of heart disease if your parents had it is several times higher.
• Availability of various chronic diseases hearts.
• You should also pay attention to the time at which shortness of breath appears, its dependence on body position and physical activity. If shortness of breath appears during physical activity, it is necessary to clarify the intensity of the exercise.

Cardiac percussion provides information about an increase in the boundaries of the heart, which occurs due to the phenomena of hypertrophy or dilatation. Normally, percussion produces a dull sound. Changes and shifts in the boundaries of cardiac dullness indicate cardiac pathologies or pathologies of other mediastinal organs.

The next step in examining the patient is auscultation ( listening). Auscultation is performed using a phonendoscope.

Using cardiac auscultation, the following changes can be determined:

• weakening of the sonority of heart sounds ( myocarditis, myocardial infarction, cardiosclerosis, valve insufficiency);
• increased sonority of heart sounds ( atrioventricular orifice stenosis);
• split heart sounds ( mitral stenosis, non-simultaneous closure of the bicuspid and tricuspid valves);
• pericardial friction rub ( dry or effusion pericarditis, after myocardial infarction);
• other noises ( with valve insufficiency, orifice stenosis, aortic stenosis).

In a general blood test for cardiac pathologies, changes in the following indicators are of interest:

• Hemoglobin is a component of red blood cells that is involved in oxygen transport. If the hemoglobin level is low, this indirectly indicates that there is a lack of oxygen in the tissues, including the myocardium.
• Leukocytes. White blood cells may be elevated in the event of an infectious process in the body. An example is infective endocarditis, myocarditis, pericarditis. Sometimes leukocytosis ( increased white blood cell count) is observed during myocardial infarction.
• Red blood cells often reduced in patients with chronic heart disease.
• Platelets participate in blood clotting. An increased number of platelets can occur due to blockage of blood vessels; when the level of platelets decreases, bleeding is observed.
• ESR () is nonspecific factor inflammatory process in the body. An increase in ESR occurs with myocardial infarction, infectious heart disease, and rheumatism.

To diagnose the causes of cardiac dyspnea, the following biochemical parameters are analyzed:

• Lipidogram, which includes such indicators as lipoproteins, cholesterol, triglycerides. This indicator indicates a disturbance in lipid metabolism, the formation of atherosclerotic plaques, which, in turn, are a factor leading to most heart diseases.
• AST (aspartate aminotransferase). This enzyme is in large quantities is in the heart. Its increase indicates the presence of damage to the muscle cells of the heart. As a rule, AST is elevated during the first day after myocardial infarction, then its level may be normal. By how much the AST level is increased, one can judge the size of the area of ​​necrosis ( cell death).
• LDH (lactate dehydrogenase). For the analysis of cardiac activity, the total level of LDH, as well as the fractions of LDH-1 and LDH-2, are important. Increased level this indicator indicates necrosis in muscle tissue heart during myocardial infarction.
• KFC (creatine phosphokinase) is a marker of acute myocardial infarction. Also, CPK can be increased with myocarditis.
• Troponin is a protein that is integral part cardiomyocytes and participates in cardiac contraction. An increase in troponin levels indicates damage to myocardial cells during acute myocardial infarction.
• Coagulogram (blood clotting) indicates the risk of blood clots and pulmonary embolism.
• Acid phosphatase increases in patients with myocardial infarction with severe course and the presence of complications.
• Electrolytes (K, Na, Cl, Ca) increase with cardiac arrhythmia or cardiovascular failure.

If cardiac shortness of breath is suspected, an x-ray examination is one of the most important and informative.

X-ray signs that indicate cardiac pathology and pathology of the heart vessels are:

• Heart sizes. An increase in heart size may occur with myocardial hypertrophy or chamber dilatation. This can occur with heart failure, cardiomyopathy, hypertension, coronary heart disease.
• Shape, configuration of the heart. You may notice an enlargement of the heart chambers.
• Saccular protrusion of the aorta due to aneurysm.
• Accumulation of fluid in the pericardial cavity during pericarditis.
• Atherosclerotic lesion of the thoracic aorta.
• Signs of heart defects.
• Congestion in the lungs, hilar infiltration in the lungs in heart failure.

CT scan of the heart and blood vessels
Computed tomography is a method of layer-by-layer examination of internal organs using x-rays. CT is an informative method that allows you to detect various pathologies of the heart, and also allows you to determine the possible risk of coronary heart disease ( cardiac ischemia) according to the degree of calcification ( deposition of calcium salts) coronary arteries.

Computed tomography can detect changes in the following structures of the heart:

• condition of the coronary arteries - the degree of calcification of the coronary arteries ( by volume and mass of calcifications), coronary artery stenosis, coronary bypass grafts, coronary artery anomalies;
• aortic diseases – aortic aneurysm, aortic dissection; measurements necessary for aortic replacement can be taken;
• condition of the heart chambers – fibrosis ( connective tissue proliferation), ventricular dilatation, aneurysm, thinning of the walls, presence of space-occupying formations;
• changes in the pulmonary veins - stenosis, abnormal changes;
• CT can detect almost all heart defects;
• pericardial pathologies – constrictive pericarditis, pericardial thickening.

An MRI allows you to obtain the following information:

• assessment of heart and valve functions;
• degree of myocardial damage;
• thickening of the myocardial walls;
• heart defects;
• pericardial diseases.

MRI is contraindicated in the presence of a pacemaker or other implants ( prosthetics) with metal parts. The main advantages of this method are its high information content and the absence of radiation to the patient.

Ultrasonography
Ultrasound is a method of examining internal organs using ultrasonic waves. Ultrasound is also one of the leading methods for diagnosing heart diseases.

Ultrasound has a number of significant advantages:

• non-invasiveness ( no tissue damage);
• harmlessness ( no radiation);
• low cost;
• quick results;
• high information content.

The following types of ultrasound examination are used to diagnose cardiac pathologies:

• Transthoracic echocardiography. In transthoracic echocardiography, the ultrasound transducer is placed on the surface of the skin. Different images can be obtained by changing the position and angle of the sensor.
• Transesophageal ( transesophageal) echocardiography. This type of echocardiography allows you to see what may be difficult to see with transthoracic echocardiography due to the presence of obstructions ( fatty tissue, ribs, muscles, lungs). In this test, the probe passes through the esophagus, which is key because the esophagus is in close proximity to the heart.

ECG
An electrocardiogram is a method of graphically recording the electrical activity of the heart. ECG is an extremely important research method. With its help, you can detect signs of cardiac pathology and signs of a previous myocardial infarction. An ECG is performed using an electrocardiograph, the results are given immediately on the spot. A qualified doctor then conducts a thorough analysis of the ECG results and draws conclusions about the presence or absence of characteristic signs of pathology.

An ECG is done both once and so-called daily ECG monitoring is carried out ( according to Holter). This method uses continuous ECG recording. At the same time, physical activity, if any, and the appearance of pain are recorded. Usually the procedure lasts 1 – 3 days. In some cases, the procedure lasts much longer - months. In this case, sensors are implanted under the skin.

Cardiac catheterization
The most commonly used method is Seldinger cardiac catheterization. The progress of the procedure is monitored by a special camera. Pre-produced local anesthesia. If the patient is restless, a sedative may also be administered. A puncture is made with a special needle femoral vein, then a conductor is installed along the needle, which reaches the inferior vena cava. Next, a catheter is placed on the guidewire, which is inserted into the right atrium, from where it can be inserted into the right ventricle or pulmonary trunk, and the guidewire is removed.

Cardiac catheterization allows you to:

• accurate measurement of systolic and diastolic pressure;
• oximetry analysis of blood obtained through a catheter ( determination of blood oxygen saturation).

Coronary angiography
Coronary angiography is a method for studying coronary ( coronary) heart arteries using x-rays. Coronary angiography is performed using catheters through which contrast agent. After administration, the contrast agent completely fills the lumen of the artery, and with the help of an X-ray machine, several images are taken in different projections, which allow us to assess the condition of the vessels.

Bicycle ergometry ( ECG with stress)
Bicycle ergometry is a research method that is performed using a special installation - a bicycle ergometer. A bicycle ergometer is a special type of exercise machine that can accurately dose physical activity. The patient sits on a bicycle ergometer, on his hands and feet ( possibly on the back or shoulder blades) the electrodes are fixed, with the help of which the ECG is recorded.

The method is quite informative and allows you to assess the body’s tolerance to physical activity and establish permissible level physical activity, identify signs of myocardial ischemia, evaluate the effectiveness of treatment, determine the functional class of angina pectoris.

Contraindications to bicycle ergometry are:

• acute myocardial infarction;
• pulmonary embolism;
• unstable angina;
• late stages of pregnancy;
• 2nd degree atrioventricular block ( disruption of the conduction of electrical impulses from the atria to the ventricles of the heart);
• other acute and severe diseases.

Treatment of cardiac dyspnea

Can be used in treatment as pharmaceuticals both surgical interventions and traditional medicine. In addition to the basic course of treatment, adherence to diet, daily routine and lifestyle adjustments are very important. It is recommended to limit excessive physical activity, stress, and treat heart disease and the risk factors leading to it.

Treatment of cardiac dyspnea is etiopathogenetic, that is, it is aimed at the causes and mechanism of its occurrence. Thus, to eliminate cardiac dyspnea, it is necessary to combat heart disease.

Groups of drugs used in the treatment of cardiac dyspnea

Traditional methods for treating shortness of breath include the following:

• Hawthorn normalizes blood circulation, has a tonic effect, hypotonic effect, lowers cholesterol levels. You can make tea, juice, infusion, and balm from hawthorn.
• Fish fat Helps reduce heart rate and helps prevent heart attacks.
• Mint, lemon balm have a calming, vasodilating, hypotensive, anti-inflammatory effect.
• Valerian used when strong heartbeats, pain in the heart, has a calming effect.
• Calendula helps with tachycardia, arrhythmia, hypertension.

Surgical methods for treating cardiac dyspnea include the following procedures:

• Coronary artery bypass surgery is an operation whose purpose is to restore normal blood flow in the coronary arteries. This is done with the help of shunts, which allow you to bypass the affected or narrowed section of the coronary artery. To do this, a section of a peripheral vein or artery is taken and sutured between the coronary artery and the aorta. Thus, blood flow is restored.
• Valve replacement, valve restoration- this is the only type of operation with which you can radically ( fully) eliminate heart defects. Valves can be natural ( biological material, human or animal) and artificial ( synthetic materials, metals).
• Pacemaker- This special device, which supports cardiac activity. The device consists of two main parts - a generator of electrical impulses and an electrode that transmits these impulses to the heart. Pacing can be external ( however, this method is now rarely used) or internal ( implantation of a permanent pacemaker).
• Heart transplant. This method is the most extreme and, at the same time, the most difficult. Heart transplantation is performed at a time when it is no longer possible to cure the disease and maintain the patient’s condition using any other methods.

Pulmonary dyspnea

Causes of pulmonary dyspnea

Conditions that most often lead to pulmonary dyspnea:

• pneumothorax;
• hemothorax;
• pulmonary embolism;
• aspiration.

The most common causes of COPD are the following:

• Smoking. 90% of COPD cases are caused by smoking ( This includes passive smoking);
• Pollution of atmospheric and indoor air with various harmful substances (dust, pollution by substances emitted by street transport and industrial enterprises);
• Recurrent ( frequently repeated) infections bronchi and lungs often lead to exacerbation and progression of COPD;
• Frequent infections respiratory tract in childhood.

The main symptoms of COPD are:

• Cough V early stage appears rarely and becomes chronic as the disease progresses.
• Sputum initially it is secreted in small quantities, then its quantity increases, it becomes viscous and purulent.
• Dyspnea- this is the latest symptom of the disease, it can appear several years after the onset of the disease, at first it appears only during intense physical exertion, then appears during normal exercise. Shortness of breath, as a rule, is of a mixed type, that is, both on inhalation and on exhalation.

Bronchial asthma
Bronchial asthma is a chronic inflammatory disease of the respiratory tract, which is characterized by periodic attacks of breathlessness. The number of asthma patients is about 5–10% of the population.

The causes of bronchial asthma include:

• hereditary factor, which occurs in approximately 30% of cases;
• allergic substances in the environment ( pollen, insects, mushrooms, animal hair);
• professional factors in the workplace ( dust, harmful gases and fumes).

The most characteristic manifestations of bronchial asthma are:

• periodic occurrence of episodes of shortness of breath;
• cough;
• feeling of discomfort in the chest;
• the appearance of sputum;
• panic.

Emphysema
Emphysema is an irreversible expansion of the air space of the distal bronchioles as a consequence of destructive changes in their alveolar walls.

Among the causes of pulmonary emphysema, there are 2 main factors:

• COPD;
• alpha-1 antitrypsin deficiency.

The main symptoms of emphysema are:

• dyspnea;
• sputum;
• cough;
• cyanosis;
• “barrel” chest;
• expansion of intercostal spaces.

Pneumonia
Pneumonia is an acute or chronic inflammation of the lungs that affects the alveoli and/or interstitial tissue of the lungs. Every year, about 7 million cases of pneumonia worldwide result in death.

Pneumonia is predominantly caused by various microorganisms and is an infectious disease.

The most common pathogens that cause pneumonia are the following:

• Pneumococcus;
• respiratory viruses ( adenovirus, influenza virus);
• legionella.

The most characteristic symptoms of pneumonia are the following:

• acute onset with fever;
• cough with copious sputum production;
• dyspnea;
• headache, weakness, malaise;
• chest pain.

Pneumothorax
Pneumothorax is the accumulation of air in pleural cavity. Pneumothorax can be open or closed, depending on the presence of communication with the environment.

Pneumothorax may occur in the following cases:

• Spontaneous pneumothorax which occurs most often. As a rule, spontaneous pneumothorax is caused by rupture of blisters due to emphysema.
• Injury– penetrating ( penetrating) chest injuries, rib fractures.
• Iatrogenic pneumothorax (related to medical care) – after pleural puncture, chest surgery, catheterization of the subclavian vein.

Clinical manifestations of pneumothorax are:

• stabbing pain in the affected part of the chest;
• dyspnea;
• asymmetrical movements of the chest;
• pale or bluish discoloration of the skin;
• coughing attacks.

Hemothorax appears as a consequence of the following factors:

• injuries ( penetrating chest wounds, closed injuries );
• medical procedures ( after surgery, puncture);
• pathologies ( tuberculosis, cancer, abscess, aortic aneurysm).

Symptoms characteristic of hemothorax are:

• pain in the chest that gets worse when coughing or breathing;
• dyspnea;
• forced sitting or semi-sitting position ( to alleviate the condition);
• tachycardia;
• pale skin;
• fainting.

Pulmonary embolism
Pulmonary embolism is a blockage of the lumen of the pulmonary artery by emboli. An embolus may be a thrombus ( most common cause of embolism), fat, tumor tissue, air.

Clinically, pulmonary embolism is manifested by the following symptoms:

• shortness of breath ( most common symptom);
• tachycardia;
• severe chest pain;
• cough, hemoptysis ( hemoptysis);
• fainting, shock.

Pulmonary embolism can lead to pulmonary infarction, acute respiratory failure, instant death. In the initial stages of the disease, with timely medical care, the prognosis is quite favorable.

Aspiration
Aspiration is a condition characterized by the penetration of foreign bodies or liquid into the respiratory tract.

Aspiration is manifested by the following symptoms:

• expiratory shortness of breath;
• sharp cough;
• suffocation;
• loss of consciousness;
• noisy breathing that can be heard from a distance.

Diagnosis of pulmonary dyspnea

Diagnosis of pulmonary dyspnea is carried out using the following methods:

• physical examination;
• general blood analysis;
• general urine analysis;
• blood chemistry;
• determination of the level of D-dimers in the blood;
• chest x-ray;
• CT, MRI;
• scintigraphy;
• pulse oximetry;
• body plethysmography;
• spirometry;
• sputum examination;
• bronchoscopy;
• laryngoscopy;
• thoracoscopy;
• Ultrasound of the lungs.

When collecting anamnesis, the following factors are of great importance:

• age;
• presence of chronic pulmonary diseases;
• conditions at the workplace, since a large number of pulmonary diseases occur due to inhalation of harmful substances and gases during work;
• smoking is an absolute risk factor for pulmonary diseases;
• decreased immunity ( the body's defenses), when the body is unable to fight pathogenic factors;
• heredity ( bronchial asthma, tuberculosis, cystic fibrosis).

When examining a patient, pay attention to the following details:

• Skin color. Skin color may be pale or bluish, reddish ( hyperemia).
• Forced position. With pleural effusion, lung abscess ( unilateral lesions) the patient tries to lie on the affected side. During an attack of bronchial asthma, the patient sits or stands and leans on the edge of a bed, table, or chair.
• Chest shape. A “barrel-shaped” chest can be caused by emphysema. Asymmetrical chest occurs with unilateral lesions.
• Fingers shaped like drumsticks appear with prolonged respiratory failure.
• Breathing characteristics– increase or decrease in the frequency of respiratory movements, shallow or deep, arrhythmic breathing.

After palpation, begin percussion ( tapping). During percussion, the lower border of the lungs and the apex of the lung are determined, and the percussion sound on the right and left is compared. Normally, the percussion sound in the area where the lungs are located is ringing and clear. With pathological changes, a clear pulmonary sound is replaced by a tympanic, dull, box sound.

Auscultation of the lungs is performed while sitting or standing. In this case, the main respiratory sounds are heard, additional ( pathological) breath sounds ( rales, crepitus, pleural friction rub).

General blood analysis
In a general blood test, there are a number of indicators that are characterized by changes during pulmonary diseases.

A complete blood count provides the following information important for diagnosing shortness of breath:

• Anemia– in pulmonary diseases it is established due to the phenomenon of hypoxia.
• Leukocytosis– purulent lung diseases, infectious diseases of the respiratory tract ( bronchitis, pneumonia).
• Increase in ESR ( erythrocyte sedimentation rate) indicates the presence of inflammatory diseases.

Blood chemistry
A biochemical blood test is a very important method of laboratory research, the results of which make it possible to judge the condition of various organs. Biochemical blood test allows you to detect active and latent diseases, inflammatory processes

For pulmonary diseases, the following biochemical blood test indicators are important:

• Total protein. With diseases of the respiratory system, it often decreases.
• Albumin-globulin ratio, in which changes occur during inflammatory lung diseases, namely, the amount of albumin decreases and the amount of globulins increases.
• SRB ( C-reactive protein) increases in inflammatory and dystrophic lung diseases.
• Haptoglobin (a protein found in blood plasma that binds hemoglobin) increases in pneumonia and other inflammatory diseases.

D-dimer level
D-dimer is a component of the fibrin protein that is involved in blood clot formation. An increase in D-dimers in the blood indicates the process of excessive thrombus formation, although it does not indicate the exact location of the thrombus. The most common causes of increased D-dimers are pulmonary embolism and malignant neoplasms. If this indicator is normal, pathology cannot be excluded, since there is a possibility of obtaining false negative results.

X-ray of the chest organs
Chest x-ray is the most common x-ray examination method.

The list of diseases detected using radiography is extensive and includes the following:

• pneumonia;
• tumors;
• bronchitis;
• pneumothorax;
• pulmonary edema;
• injuries;
• other.

Diseases of the respiratory system can be detected by the following signs:

• decreased transparency of lung tissue;
• darkening of the lung fields is the main radiological sign pneumonia ( associated with inflammatory changes in lung tissue), atelectasis;
• increased pulmonary pattern - COPD, tuberculosis, pneumonia;
• expansion of the root of the lung - chronic bronchitis, tuberculosis, expansion of the pulmonary arteries;
• foci of pneumosclerosis in COPD, chronic bronchitis, atelectasis, pneumoconiosis;
• smoothness of the costophrenic angle – pleural effusion;
• a cavity with a horizontal level of fluid is characteristic of a lung abscess.

Thus, using CT and MRI, the following diseases can be diagnosed:

• tumors;
• tuberculosis;
• pneumonia;
• pleurisy;
• enlarged lymph nodes.

The procedure is carried out in two stages:

• Blood supply scintigraphy. A labeled radioactive substance is injected intravenously. When the substance decays, it emits radiation, which is recorded by a camera and visualized on a computer. The absence of radiation indicates the presence of an embolism or other pulmonary disease.
• Ventilation scintigraphy. The patient inhales a radioactive substance, which, along with the inhaled air, spreads through the lungs. If you find an area where gas does not enter, this indicates that something is blocking the flow of air ( tumor, fluid).

Pulse oximetry
Pulse oximetry is a diagnostic method for determining blood oxygen saturation. Normal oxygen saturation should be 95 – 98%. When this indicator decreases, they speak of respiratory failure. The manipulation is carried out using a pulse oximeter. This device is fixed on a finger or toe and calculates the content of oxygenated ( oxygenated) hemoglobin and pulse rate. The device consists of a monitor and a sensor that detects pulsation and provides information to the monitor.

Bodyplethysmography
Body plethysmography is a more informative method compared to spirography. This method allows you to analyze in detail the functional capacity of the lungs, determine the residual lung volume, total lung capacity, functional residual lungs, which cannot be determined with spirography.

Spirometry
Spirometry is a diagnostic method that examines the function of external respiration. The study is carried out using a spirometer. During the examination, the nose is pinched with fingers or with a clamp. To avoid unwanted effects ( dizziness, fainting) it is necessary to strictly follow the rules and constantly monitor the patient.

Spirometry can be performed with calm and forced ( reinforced) breathing.

During quiet breathing, vital capacity is determined(vital capacity)and its components:

• expiratory reserve volume ( after taking the deepest breath possible, exhale as deeply as possible);
• inspiratory volume ( after exhaling as deeply as possible deep breath ).

With forced breathing, FVC is determined ( forced vital capacity). To do this, exhale calmly, inhale as deeply as possible, and then immediately exhale as deeply as possible without pause. FVC decreases with pathology of the pleura and pleural cavity, obstructive pulmonary diseases, and disturbances in the functioning of the respiratory muscles.

Sputum analysis
Sputum is a pathological discharge secreted by the glands of the bronchi and trachea. Normally, these glands produce a normal secretion, which has a bactericidal effect and helps in the release of foreign particles. At various pathologies respiratory system produces sputum ( bronchitis, tuberculosis, lung abscess).

Before collecting material for research, it is recommended to drink a large volume of water 8–10 hours in advance.

Sputum analysis includes the following points:

• Initially, the characteristics of sputum are analyzed ( content of mucus, pus, blood, color, smell, consistency).
• Then microscopy is performed, which informs about the presence of various formed elements in the sputum. Microorganisms can be detected.
• Bacteriological analysis carried out to detect microorganisms, possible infectious agents.
• Determination of sensitivity to antibiotics ( antibiogram) allows you to find out whether the detected microorganisms are sensitive or resistant to antibacterial drugs, which is very important for adequate treatment.

Using bronchoscopy, the mucous membrane of the trachea and bronchi is examined ( even the smallest branches). This is the most suitable method for visualizing the inner surface of the bronchi. Bronchoscopy allows you to assess the condition of the mucous membrane of the respiratory tract, identify the presence of inflammatory changes and the source of bleeding, take material for a biopsy, and remove foreign bodies.

Preparation for bronchoscopy consists of the following:

• the last meal should be 8 hours before the procedure to prevent aspiration of gastric contents in case of possible vomiting;
• Before the procedure, premedication is recommended ( pre-administration of drugs);
• conducting a detailed blood test and coagulogram before the procedure;
• It is recommended not to drink liquids on the day of the test.

• local anesthesia of the nasopharynx is performed;
• the bronchoscope is inserted through the nose or mouth;
• the doctor gradually examines the condition of the mucous membrane as the device is introduced;
• if necessary, material is taken for a biopsy, a foreign body is removed, or another necessary medical procedure is performed;
• At the end of the procedure, the bronchoscope is removed.

Laryngoscopy
Laryngoscopy is a research method in which the larynx is examined using a special device called a laryngoscope.

There are two methods for performing this manipulation:

• Indirect laryngoscopy. This method is currently considered outdated and is used quite rarely. The essence is to introduce a special small mirror and visualization of the mucous membrane using a reflector that illuminates it. To avoid gagging, local spraying with an anesthetic solution is carried out ( pain reliever).
• Direct laryngoscopy. This is a more modern and informative research method. There are two options – flexible and rigid. In flexible laryngoscopy, the laryngoscope is inserted through the nose, the larynx is examined, and then the device is removed. Rigid laryngoscopy is a more complex method. During this procedure, it is possible to remove foreign bodies and take material for a biopsy.

Thoracoscopy has several advantages:

• low-injury;
• information content
• manipulation can be carried out before open operations to argue for the need for one or another type of treatment.

However, there are a number of lung diseases that can be diagnosed using ultrasound:

• accumulation of fluid in the pleural cavity;
• lung tumors;
• lung abscess;
• pulmonary tuberculosis.

Treatment of pulmonary dyspnea

Treatment of pulmonary dyspnea is carried out using the following methods:

• Therapeutic, which includes medications and non-drug therapies.
• Surgical method.

Non-drug therapy for pulmonary dyspnea includes:

• rejection of bad habits ( primarily from smoking);
• breathing exercises;
• active immunization against pneumococcus, influenza virus;
• rehabilitation of chronic foci of infection.

Drug therapy

If other treatment methods are ineffective, surgical methods of treatment are resorted to. In some cases, surgery is the only chance for a patient’s recovery.

Surgical methods for treating pulmonary dyspnea include:

• Pleural puncture (thoracentesis) is a puncture of the pleural cavity. The pleural cavity is located between the two layers of the pleura. The puncture is performed in a sitting position. A place for puncture is selected, disinfected, then done local anesthesia novocaine solution ( if there is no allergic reaction to it). After this, an injection is given in this area; when a feeling of failure is felt, this means that the parietal pleura has been punctured and the manipulation is successful. Next, the syringe plunger is pulled and the liquid is evacuated ( blood, pus, effusion). It is not recommended to pull out a large amount of liquid at one time, as this is fraught with complications. After removing the needle, the puncture site is treated with an antiseptic and a sterile bandage is applied.
• Thoracotomy is an operation in which open access to the chest organs is performed through opening the chest wall.
• Drainage of the pleural cavity (Bülau drainage) is a manipulation to remove fluid and air from the pleural cavity using drainage.
• Surgical reduction of lung volume. The part of the lungs damaged by emphysema cannot be treated or restored. In this regard, an operation is carried out to surgical reduction lung volume, that is, the non-functional part of the lung is removed so that the less damaged part can function and provide gas exchange.
• Lung transplant. This is a very serious operation that is performed for progressive, chronic fibrosing lung diseases. Transplantation is a radical surgical method that consists of completely or partially replacing the diseased lungs of a sick person with healthy ones taken from a donor. Transplantation, despite the complexity of its implementation and postoperative therapy, significantly increases the length and quality of life of the patient.

Anemia as a cause of shortness of breath

Causes of anemia

Nutritional deficiencies most often occur for the following reasons:

• vegetarian diets;
• long-term diets on exclusively dairy products;
• poor quality nutrition among low-income populations.

A lack of iron in the body causes disturbances in the formation of hemoglobin, which binds and transports oxygen to tissues. Thus, tissue hypoxia and corresponding symptoms develop. Anemia associated with a lack of iron is called iron deficiency and is the most common.

Malabsorption nutrients
In some cases, the necessary nutrients are present in the required quantities in the diet, but due to certain pathologies they are not absorbed in the gastrointestinal tract.

Malabsorption of nutrients most often occurs in the following cases:

• malabsorption syndrome ( nutrient malabsorption syndrome);
• gastrectomy ( removal of part of the stomach);
• resection of the proximal part of the small intestine;
• chronic enteritis ( chronic inflammation of the small intestine).

These periods include:

• teenage years;
• pregnancy;

Anemia as a result of massive blood loss can result from:

• injuries;
• bleeding in the gastrointestinal tract ( gastric and duodenal ulcers, Crohn's disease, diverticulosis, esophageal varices);
• blood loss during menstruation;
• donation;
• hemostasis disorders.

Drugs that can cause anemia include:

• antibiotics;
• antimalarials;
• antiepileptic drugs;
• antipsychotic medications.

Tumors
The mechanism of anemia in malignant tumors is complex. In this case, anemia may appear as a result of massive blood loss ( colorectal cancer), lack of appetite ( which, in turn, leads to insufficient intake of nutrients necessary for hematopoiesis into the body), taking antitumor drugs that can lead to suppression of hematopoiesis.

Intoxication
Poisoning with substances such as benzene and lead can also lead to the development of anemia. The mechanism is increased destruction of red blood cells, impaired synthesis of porphyrins, and damage to the bone marrow.

Genetic factor
In some cases, anemia is established as a result of anomalies that occur at the gene level.

Abnormalities that lead to anemia include:

• defect in the red blood cell membrane;
• disruption of hemoglobin structure;
• enzymopathies ( disruption of enzyme systems).

Diagnosis of anemia

General blood count indicators important for diagnosing anemia

For effective treatment Anemia requires adherence to several principles:

• Treatment of chronic diseases that cause anemia.
• Dieting. Balanced diet with sufficient nutrients necessary for hematopoiesis.
• Taking iron supplements for iron deficiency anemia. Iron supplements are usually given orally, but in rare cases they may be given intravenously or intramuscularly. However, with this administration of the drug there is a risk of developing an allergic reaction, and the effectiveness is lower. Iron preparations include sorbifer, ferrum lek, ferroplex.
• Taking cyanocobalamin ( subcutaneous injections) before normalization of hematopoiesis and after for prevention.
• Stopping bleeding in anemia caused by blood loss with various medications or through surgery.
• Transfusions ( transfusion) blood and its components are prescribed in case of a patient’s serious condition that threatens his life. Reasoned prescription of blood transfusions is necessary.
• Glucocorticoids are prescribed for anemia caused by autoimmune mechanisms ( that is, antibodies are produced against one’s own blood cells).
• Folic acid preparations in tablets.

• increase in hemoglobin level in the third week of treatment;
• increase in the number of red blood cells;
• reticulocytosis on days 7–10;
• disappearance of symptoms of sideropenia ( iron deficiency in the body).

Why does shortness of breath occur during pregnancy?

During pregnancy, shortness of breath occurs for the following reasons:

• Dyspnea as a compensatory mechanism. Shortness of breath appears as a mechanism of the body’s adaptation to the increased need for oxygen during pregnancy. In this regard, changes occur in the respiratory system - the frequency and depth of breathing increases, the work of the respiratory muscles increases, and vital capacity increases ( vital capacity) and tidal volume.
• Hormonal changes in the body also affects the appearance of shortness of breath. For normal course During pregnancy, the body experiences changes in the production of hormones. So, progesterone ( a hormone that is produced in large quantities by the placenta during pregnancy), stimulating the respiratory center, helps to increase pulmonary ventilation.
• Fetal weight gain. As the weight of the fetus increases, the uterus becomes enlarged. The enlarged uterus gradually begins to put pressure on nearby organs. When pressure begins on the diaphragm, breathing problems begin, which primarily manifest as shortness of breath. Shortness of breath is usually mixed, that is, both inhalation and exhalation are difficult. In about 2–4 weeks, changes occur in the pregnant woman’s body that affect the breathing process. The uterus drops down by 5–6 centimeters, which leads to easier breathing.

Pathological shortness of breath during pregnancy can result from:

• Anemia is a condition that often appears during pregnancy. Due to hemoglobin related disorders ( disruption of synthesis, insufficient intake of iron into the body), oxygen transport to tissues and organs is disrupted. As a result, hypoxemia occurs, that is, low oxygen content in the blood. Therefore, it is especially important to monitor the level of red blood cells and hemoglobin in a pregnant woman to avoid complications.
• Smoking. There are many reasons for shortness of breath when smoking. Firstly, damage occurs to the mucous membrane of the respiratory tract. Also, atherosclerotic plaques accumulate on the walls of blood vessels, which contributes to poor circulation. In turn, impaired blood circulation affects the breathing process.
• Stress is a factor that contributes to an increase in the respiratory rate and heart rate; it is subjectively felt as a lack of air, a feeling of tightness in the chest.
• Respiratory system diseases (bronchial asthma, bronchitis, pneumonia, COPD).
• Diseases of the cardiovascular system (cardiomyopathy, heart disease, heart failure).

• elevated temperature;
• dizziness and loss of consciousness;
• cough;
• pallor or cyanosis;
• headache;
• fatigue and malaise.

Why does shortness of breath occur with osteochondrosis?

Dyspnea with osteochondrosis develops most often for the following reasons:

• Reducing the space between vertebrae. Due to degenerative changes ( violations in the structure) of the vertebrae and the spine as a whole, the intervertebral discs gradually become thinner. Thus, the space between the vertebrae is reduced. And this, in turn, contributes to pain, stiffness and shortness of breath.
• Vertebral displacement. With the progressive course of the disease, dystrophic changes ( characterized by cell damage) in tissues can also lead to displacement of the vertebrae. Displacement of different vertebrae can lead to characteristic consequences. Dyspnea, as a rule, forms when the first thoracic vertebra.
• Compression of blood vessels. When the space between the vertebrae decreases or they are displaced, the vessels are compressed. Thus, the blood supply to the diaphragm, which is the main respiratory muscle, becomes problematic. Also, with cervical osteochondrosis, compression of the neck vessels occurs. At the same time, the blood supply to the brain deteriorates, vital centers in the brain are depressed, including the respiratory center, which leads to the development of shortness of breath.
• Pinched or damaged nerve roots can lead to sharp pain, which is accompanied by difficulty breathing and shortness of breath, especially when inhaling. Pain due to osteochondrosis limits breathing movements.
• Deformation ( violation in the structure) chest. Due to the deformation of individual vertebrae or parts of the spinal column, deformation of the chest occurs. In such conditions, breathing becomes difficult. The elasticity of the chest also decreases, which also limits the ability to breathe fully.

To prevent the appearance of shortness of breath during osteochondrosis, you must adhere to the following rules:

• timely diagnosis of osteochondrosis;
• adequate drug treatment;
• physiotherapeutic procedures and massage;
• physiotherapy;
• avoiding prolonged stay in one position;
• matching bed and pillow for quality rest during sleep;
• breathing exercises;
• avoiding a sedentary lifestyle;
• avoiding excessive physical activity.

What to do if a child has shortness of breath?

Normally, the frequency of respiratory movements in a child is higher than in adults. There are normal breathing rates for each age group, so don't panic if your child's breathing rate seems elevated. Perhaps this is just the norm for his age. Respiration rate is measured in calm state, without physical activity or stress preceding the measurement. It is best to measure the respiratory rate while the child is sleeping.

Respiratory rate norms for children of different age groups

If a child experiences shortness of breath, you can contact family doctor, pediatrician, cardiologist, pulmonologist. In order to get rid of shortness of breath in a child, you should find its cause and fight the cause.

Shortness of breath in a child may occur as a result of the following factors:

• rhinitis ( inflammation of the nasal mucosa) can also lead to shortness of breath by making it difficult for air to pass through the airways;
• bronchial asthma, which is manifested by periodic attacks of severe shortness of breath, and the diagnosis of which in childhood is sometimes quite difficult to establish;
• viral diseases ( influenza virus, parainfluenza virus, adenovirus);
• heart disease ( heart defects), which in addition to shortness of breath are also manifested by cyanosis and developmental delays in the child;
• lung diseases ( pneumonia, emphysema);
• entry of a foreign body into the respiratory tract is a condition that requires immediate intervention, as this can very quickly lead to death;
• hyperventilation syndrome, which manifests itself during stress, panic disorder, hysteria; in this case, the level of carbon dioxide in the blood decreases, which, in turn, contributes to hypoxia;
• cystic fibrosis is a genetic disease characterized by serious disorders of respiration and exocrine glands;
• physical exercise;
• diseases immune system;
• hormonal imbalance.

Is it possible to treat shortness of breath using traditional methods?

Traditional medicine has many means and methods for treating shortness of breath, which have various mechanisms actions. Such remedies can be taken in the form of solutions, tinctures, and teas.

The following traditional medicine methods can be used to treat shortness of breath:

• Cranberry infusion. Pour 5 tablespoons of cranberries into 500 ml of boiling water, let it brew for several hours, then add 1 teaspoon of honey. The prepared infusion should be drunk within 24 hours.
• Infusion of wormwood. To prepare the infusion, you need to pour boiling water over 1–2 teaspoons of wormwood and let it brew for half an hour. After the infusion is ready, take 1 teaspoon half an hour before meals 3 times a day.
• Astragalus root infusion prepared on a water basis. To do this, take 1 tablespoon of dried and crushed astragalus root and pour boiling water over it. Then you need to let the mixture brew for several hours. The finished tincture is taken 3 times a day, 3 tablespoons.
• A mixture of honey, lemon and garlic. To prepare the mixture, you need to add 10 peeled and chopped heads of garlic to 1 liter of honey, and also squeeze the juice from 10 lemons. Then you need to tightly close the container in which the mixture is prepared and put it in a dark place for 1 - 2 weeks. After this, the medicine is ready for use. It is recommended to drink 1 teaspoon of this medicine 3 – 4 times a day.
• Infusion of potato sprouts. First you need to dry it well, then chop and grind the raw materials. Dried sprouts are poured with alcohol and infused for 10 days. It is recommended to take the infusion 1 – 3 potassium 3 times a day.
• Motherwort infusion. Pour 1 tablespoon of motherwort into a glass of boiling water, let it brew for an hour, and then drink half a glass 2 times a day.
• Melissa infusion. 2 tablespoons of dried lemon balm leaves are poured with a glass of boiling water and infused for 30 minutes. Take the product 3-4 times a day, 3-4 tablespoons.
• Infusion of hawthorn flowers. To prepare the infusion, pour 1 teaspoon of hawthorn flowers into 1 glass of boiling water and leave for 1 – 2 hours. Once ready, the infusion is taken 3 times a day, 1/3 cup.

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shortness of breath, forcing the patient to remain in a sitting or standing position due to its sharp increase in the horizontal position of the body; characteristic of left atrial and left ventricular heart failure - see Shortness of breath.

1. Small medical encyclopedia. - M.: Medical encyclopedia. 1991-96 2. First aid. - M.: Great Russian Encyclopedia. 1994 3. encyclopedic Dictionary medical terms. - M.: Soviet encyclopedia. - 1982-1984.

See what “Orthopnea” is in other dictionaries:

Noun, number of synonyms: 1 shortness of breath (10) ASIS Dictionary of Synonyms. V.N. Trishin. 2013… Synonym dictionary

- (orthopnoe; ortho + Greek. breathing) a forced sitting position taken by the patient to facilitate breathing with severe shortness of breath ... Large medical dictionary

ORTHOPNEA- (from the Greek orthos direct and pnoo breathing), the highest degree of shortness of breath that occurs with circulatory failure... Veterinary encyclopedic dictionary

ORTHOPNEA- (orthopnoea) difficulty breathing when lying down, forcing a person to sleep in a semi-sitting position in bed or sitting on a chair. Orthopnoeic… Dictionary in medicine

Difficulty breathing when lying down, forcing a person to sleep in a semi-sitting position in bed or sitting on a chair. Orthopnoeic. Source: Medical Dictionary... Medical terms

I Shortness of breath (dyspnoe) is a disturbance in the frequency, depth or rhythm of breathing or a pathological increase in the work of the respiratory muscles due to an obstacle to exhalation or inhalation, accompanied, as a rule, by subjectively painful sensations of lack of air,... ... Medical encyclopedia

Various inhalers used for bronchial asthma ... Wikipedia

I Myocarditis Myocarditis (myocarditis; Greek + myos muscle + kardia heart + itis) is a term that unites a large group of different etiologies and pathogenesis of myocardial lesions, the basis and leading characteristic of which is inflammation. Secondary... ... Medical encyclopedia

Vascular crises in patients with hypertension, most often developing in the form of acute disorders of cerebral hemodynamics or acute heart failure against the background of a pathological increase in blood pressure. There are several... ... Medical encyclopedia

I Heart failure is a pathological condition caused by the inability of the heart to provide adequate blood supply to organs and tissues during exercise, and in more severe cases, at rest. In the classification adopted at the XII Congress... ... Medical encyclopedia

With various diseases, a person, in order to alleviate his suffering, often puts his body in a forced position. By observing him, we can obtain very important information, including determining the location of pain. Here are some examples:
“fetal position”– can often be seen with pancreatitis. The patient lies on his side with his legs pulled towards his stomach.

the patient is bent towards the side of pain– for renal and periumbilical abscess.

frozen position– with peritonitis (any movement increases pain), angina pectoris.

expressed concern– intestinal obstruction, myocardial infarction.

the patient lies on his back with the leg bent at the knee and the hip abducted (symptom of the psoas muscle)– observed in the case of local damage to the area located near the iliopsoas muscle. This may happen with local inflammatory process near the iliopsoas muscle (in the appendix, terminal ileum in Crohn's disease, as well as intestinal diverticulum), as well as if the muscle itself is inflamed. Until recently lumbar muscles could be observed with a “cold” tuberculous abscess of the spine, which spread down the course of this muscle and proceeded without fever or other signs of inflammation. Nowadays, damage to the iliopsoas muscle can be found with an intramuscular hematoma, which can be provoked by anticoagulant therapy.

“Muslim praying pose”(sitting in bed, leaning forward) – observed with pericardial effusion (especially with cardiac tamponade). In this case, you can often see significantly swollen neck veins.

Positional changes in respiratory disorders.

Platypnea– difficulty breathing that occurs in an upright position. The patient feels better in the supine position. Often combined with orthodeoxy– a condition in which deterioration of hemoglobin oxygen saturation occurs in a vertical position.

Platypnea can occur with:

recurrent pulmonary embolism(gravity provokes damage mainly to the basal parts of the lungs)

pleural effusion, bilateral lower lobe pneumonia(fluid accumulates in lower sections lungs, which provokes the appearance of bilateral lower lobe atelectasis).

liver cirrhosis(with bilateral lower lobe arteriovenous shunting)

atrial septal defect(for this there must also be an increase in pressure in pulmonary vessels(eg, lobectomy, pneumonectomy) or pleural effusion)

Orthopnea– a condition in which difficulty breathing appears or worsens when lying down, disappearing when sitting. In 95% of cases, it is caused by heart disease. The fact is that when a person sits, there is a redistribution of blood to the underlying areas. This leads to a decrease in venous return, and the preload on the ventricles of the heart is reduced. Thus, orthopnea is a fairly effective and rapid mechanism for eliminating blood stagnation in the pulmonary circulation (PCC). But we must remember that long-term left ventricular failure can be complicated by the fact that right ventricular failure will also join it. In this case, if the left ventricle is unloaded and congestion in the ICC decreases, it will become easier for the patient to breathe while lying down than standing or sitting.

Orthopnea in lung disease. Causes:

bilateral damage to the apexes of the lungs, especially with the formation of bullae. At the same time, in a sitting position, perfusion of the lower parts of the lungs improves, which leads to a decrease in shortness of breath.

COPD. By occupying the orthopneic position, the patient provides himself with not only improved gas exchange, but also respiratory mechanics, because stretching of the additional respiratory muscles is observed. The patient unconsciously chooses a position in which he rests his forearms, fixes his shoulders and neck muscles, facilitating the work of the respiratory muscles (his arms clasp the edge of the bed or rest on his hips - S. Dahl).

for bronchial asthma, orthopnea helps assess its severity. It is considered an unfavorable prognostic sign. And if the patient cannot take a horizontal position, this, along with sweating, indicates a deterioration in lung function and is an indication for hospitalization.

The same forced position can be occupied by a patient with laryngeal stenosis.

Trepnea– a condition in which the patient prefers lying on his side to lying on his side or sitting.

Lying position on the “healthy side”– observed in diseases affecting one lung:

unilateral lung collapse with bronchial obstruction; massive pleural effusion, which compresses the lung from the outside.

dry pleurisy– shifting to the affected side leads to a sharp increase in pain.

But in some situations the position on the “healthy side” can be very dangerous . For example, if we are talking about unilateral pneumonia or hemorrhagic lung damage, because there is a danger of pus/blood flowing from the affected lung to the healthy one. In such cases, the patient should lie on the “sick side”.

Position on the “sick side”.

abscess or gangrene of the lung, pulmonary form tuberculosis, effusion and dry pleurisy– in this case, the unaffected lung is more fully used in the act of breathing and coughing is less bothersome.

attack of appendicitis.

Other poses

knee-elbow– can be observed during exacerbation peptic ulcer, effusion pericarditis.

“cocked hammer” – (the patient is on his side. The legs are brought to the stomach, the head is thrown back) – with inflammation in the membranes of the spinal cord and brain.

sitting, leaning forward (mostly on a pillow)– you can suspect effusion pericarditis, aortic aneurysm, pancreatic cancer with damage to the solar plexus.

Interview a patient with bronchial asthma and identify complaints:

expiratory shortness of breath, characterized by sharply difficult exhalation, while the inhalation is short and the exhalation is prolonged; attacks of suffocation that occur at any time of the day, especially at night or early in the morning, in frosty weather, in strong winds, during the flowering period of some plants and lasting from several hours to 2 or more days (asthmatic condition), paroxysmal cough with scanty discharge the amount of viscous, glassy sputum that occurs after physical activity, when inhaling allergens, worse at night or upon awakening; the appearance of episodes of wheezing or a feeling of tightness in the chest under the above conditions.

Collect anamnesis from a patient with an infectious-allergic form of bronchial asthma: indications of past diseases of the upper respiratory tract (rhinitis, sinusitis, laryngitis, etc.), bronchitis and pneumonia; the occurrence of the first attacks of suffocation after them; a cold that “sinks into the chest” or lasts more than 10 days. In subsequent years, the frequency of occurrence of asthma attacks, their connection with cold, damp weather, acute respiratory diseases (influenza, bronchitis, pneumonia). Duration of attack and inter-attack periods of the disease. The effectiveness of treatment and its results in outpatient and inpatient settings. Use of medications, corticosteroids. The presence of complications - the formation of pneumosclerosis, pulmonary emphysema, the addition of respiratory and pulmonary-heart failure.

Collect anamnesis from a patient with atonic form of bronchial asthma: exacerbations of the disease are seasonal, accompanied by rhinitis, conjunctivitis; Patients have urticaria, Quincke's edema, intolerance to certain foods (eggs, chocolate, oranges, etc.), medicines, odorous substances, and a hereditary predisposition to allergic diseases.

Conduct a general examination of the patient. Assess the patient's condition (which may be serious), position in bed: during an attack of bronchial asthma, the patient takes a forced position, usually sitting in bed, with his hands resting on his knees or the back of a chair. The patient breathes loudly, frequently, with whistling and noise, the mouth is open, the nostrils flare. When you exhale, swelling of the neck veins appears, which decreases when you inhale. There is diffuse diffuse cyanosis.

Identify the symptoms of bronchial asthma in a patient during examination of the respiratory organs: upon examination, the chest is emphysematous, during an attack it expands and takes an inspiratory position (in the position of maximum inspiration). The auxiliary muscles, muscles of the shoulder girdle, back, and abdominal wall are actively involved in breathing. On palpation, a rigid chest is determined, weakening voice tremors in all departments due to increased airiness of the lung tissue. With comparative percussion, the appearance of a box sound over the entire surface of the lungs is noted, with topographic percussion: displacement of the boundaries up and down, an increase in the width of Krenig’s fields, limited mobility of the lower pulmonary edge. When auscultating the lungs against the background of weakened breathing, a large number of dry whistling rales are heard, often audible even at a distance. Bronchophony is weakened over the entire surface of the lungs.

Identify symptoms of bronchial asthma during examination of the cardiovascular system: upon examination, the apical impulse is not detected, swelling of the jugular veins is noted. On palpation, the apical impulse is weakened, limited or not determined. The boundaries of relative dullness of the heart are difficult to determine during percussion, and absolute dullness is not determined due to acute swelling of the lungs. On auscultation, the heart sounds are weakened (due to the presence of pulmonary emphysema), the accent of the second tone is over the pulmonary artery, tachycardia.

During laboratory research In a patient with bronchial asthma, the peripheral blood is characterized by the appearance of eosinophilia and moderate lymphocytosis. When examining sputum, the mucous membrane is glassy and viscous; microscopic examination reveals many eosinophils, often Courshman spirals and Charcot-Leyden crystals.

Identify the symptoms of bronchial asthma in a patient with a chest x-ray: There is an increase in the transparency of the pulmonary fields and limited mobility of the diaphragm.

Assess external respiration function: bronchial asthma is characterized, first of all, by a decrease in bronchial patency indicators (FEV I Tiffno test). Bronchial obstruction is reversible. There is an increase in OO and TEL.

Differentiate an attack of bronchial asthma from an attack of cardiac asthma(see table 6) and bronchial asthma from chronic obstructive bronchitis(see Table 7).

Table 6

Distinctive signs of attacks of bronchial and cardiac asthma

However, it should be remembered that with a prolonged attack of cardiac asthma, due to the addition of congestive bronchitis, it may acquire some features of bronchial asthma (expiratory shortness of breath, dry wheezing).

Table 7

Difference between bronchial asthma and chronic obstructive bronchitis

The main cause of orthopnea is the transfer of fluid from the legs and abdominal cavity into the chest when the body is horizontal, which leads to an increase in hydrostatic pressure in the pulmonary capillaries. The feeling of shortness of breath in a sitting position, as a rule, weakens, since this reduces venous return and pressure in the pulmonary capillaries.

The information posted on the pages of the site is not a guide to self-medication.

If you detect or suspect diseases, you should consult a doctor.

Orthopnea

Orthopnea is severe shortness of breath associated with stagnation in the pulmonary circulation, in which the patient cannot lie down and is forced to sit. When sitting, venous congestion moves to the lower extremities, while blood supply to the small circle decreases, heart function and gas exchange are facilitated, and oxygen starvation is reduced. The head end of the patient's bed should be elevated or the patient needs a chair.

The body position during orthopnea creates more favorable circulatory conditions in patients with heart damage: venous stagnation in the area lower limbs and the portal vein leads to a decrease in blood flow to the heart and blood supply to the vessels of the small circle; the lumen of the alveoli increases, which leads to an increase in the vital capacity of the lungs.

Improved gas exchange in the lungs during orthopnea is also achieved due to the more active participation of the diaphragm and respiratory muscles in the act of breathing. Reducing pulmonary congestion reduces reflex stimulation of the respiratory center, and improving gas exchange in the lungs to a certain extent reduces oxygen starvation of body tissues, including the myocardium, which improves the contractility of the heart and reduces shortness of breath. In addition, orthopnea reduces cerebral venous congestion, thereby facilitating the functioning of the circulatory and respiratory centers.

Orthopnea

Orthopnea is a symptom that occurs when the patient takes a supine position. Patients with this pathology complain of shortness of breath, which forces them to take a forced position - a sitting position, even during sleep.

Etiology

The symptom is associated with congestion of the pulmonary circulation. When accepted by patients horizontal position excess fluid passes from the abdominal cavity into the chest, exerts pressure on the diaphragm, which provokes shortness of breath.

The causes of the symptom are as follows:

1. The most common is severe left ventricular heart failure. The latter is provoked by many other diseases - angina pectoris, arterial hypertension, cardiomyopathies, pericarditis, myocardial infarction, heart defects.
2. Shortness of breath while lying down can be a manifestation of bronchial asthma or chronic obstructive pulmonary disease, sometimes chronic bronchitis.
3. The rarest cause is diaphragm paresis, which develops as a result of the patient’s birth injury and manifests itself in childhood.

Clinical picture

As mentioned above, with orthopnea, patients will complain of a lack of air when they assume a horizontal position. To alleviate the condition, patients place several pillows under their heads. The upper part of the body rises above the lower part, fluid outflows to the lower extremities, the severity of orthopnea is significantly reduced, and patients can fall asleep.

If, during a night's rest in bed, the head accidentally moves from the elevation, patients immediately wake up from coughing and shortness of breath.

Also, significant relief is noted when taking a sitting position. In such cases, excess fluid moves to the lower half of the body, it stops putting pressure on the diaphragm, and patients immediately begin to breathe better.

Inflow fresh air also alleviates the condition of orthopnea; quite often patients sit on a chair in front of an open window.

Diagnostics

During diagnosis, it is necessary to differentiate and determine the origin of shortness of breath - pulmonary or cardiac. A general examination of the patient with clarification of complaints, analysis of life history and illness is mandatory. With cardiac pathologies, symptom progression usually occurs much faster than with respiratory diseases.

Patients undergo spirography, which shows the patency of bronchi of various sizes and allows one to determine the symptoms of obstruction.

Ultrasound examination of the heart and abdominal organs is also shown, showing signs of excess fluid in the body. Using ultrasound, indicators of heart function are determined, on the basis of which we can conclude about the presence or absence of signs of organ failure. For this purpose, patients undergo bicycle ergometry, which also gives an idea of ​​the functionality of the heart muscle.

Patients also have a cardiogram recorded, showing changes in heart rhythm. For more in-depth research this process patients are prescribed Holter monitoring.

From laboratory tests, a biochemical blood test is important, giving an idea of ​​the level of blood electrolytes, which is also indirect sign heart failure. Glucose and lipid levels are important. When they increase, drug therapy is necessary, otherwise serious complications may develop.

Treatment of orthopnea

When treating orthopnea, the effect occurs on the main cause that provoked the appearance of the symptom. Treatment is usually carried out in outpatient setting a general practitioner with the help of a cardiologist or pulmonologist.

In the case of lung pathology, tactics must be comprehensive. It is necessary to exclude contact with allergens (dust, wool, plants, products, medications), which may trigger the symptoms. It is important to constantly clean the living space; the air inside must be humidified.

Also, patients with bronchial asthma or chronic obstructive disease are prescribed drugs that dilate the airways, thereby increasing their patency and relieving the symptoms of shortness of breath. Medicines are prescribed in inhalation forms from the groups of beta-agonists and glucocorticoids. These drugs have not only a bronchodilator, but also an anti-inflammatory effect. Dosages and frequency of administration are determined only by the attending physician.

As for left ventricular failure, the approach to treatment is also comprehensive. Diuretics (diuretics) are prescribed to remove excess fluid. In order to quickly evacuate it, drugs can be administered intravenously with subsequent transition to tablet forms. First, furosemide is used, after stabilization of the patient's condition, indapafone or spironolactone is prescribed.

To reduce the load on the heart muscle, medications from the group of beta blockers (metoprolol, bisoprolol) are used. They help lower blood pressure and reduce heart rate.

In the presence of rhythm disturbances of various etiologies and severity, the use of antiarrhythmic drugs. For left ventricular heart failure, glycosides can be prescribed, which significantly reduce the contraction frequency, thereby reducing the load on the heart.

In addition, patients are prescribed antiplatelet drugs - drugs that help reduce blood viscosity, and statins. The latter reduce blood cholesterol levels. Taking these drugs is aimed at preventing thrombosis.

Medicines are used for life, their prescription, as well as adjustments to therapy, are carried out only by a specialist.

Prevention

Preventing the occurrence of orthopnea also directly depends on the pathology that provoked the symptom.

If you have respiratory diseases, you must follow all your doctor’s recommendations for taking medications. It is also important to avoid contact with allergens and keep the apartment clean. It is useful to attend sessions of physiotherapy, massage and inhalations. At home, it is recommended to perform special breathing exercises.

In case of pathology of the cardiovascular system, in addition to constantly taking medications, it is important to take measures to correct lifestyle. Patients must follow a diet that excludes salt from the diet and limits fluid volume. Fatty meats, smoked meats, fried foods, herbs and spices, and baked goods are removed from the menu. Chicken and beef meat, vegetables and fruits, dairy products with a small percentage of fat content, cereals, and dried fruits are healthy.

It is extremely important for patients to get rid of bad habits - smoking and drinking alcoholic drinks. Physical education and sports are required. Initially, the loads are small, but gradually they can be increased. Running, walking, cycling, swimming, dancing, cardio training are useful.

Gasanova Sabina Pavlovna

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Biology and medicine

Orthopnea (shortness of breath when lying down)

Shortness of breath that occurs when lying down, called orthopnea, is more common in heart failure, but can sometimes be a manifestation of bronchial asthma and chronic airway obstruction. This symptom almost always occurs with such a rare pathology as bilateral diaphragmatic paresis.

Dyspnea while lying down appears later than dyspnea on exertion. The causes of orthopnea are the transfer of fluid from the abdominal cavity and legs into the chest with an increase in hydrostatic pressure in the pulmonary capillaries and a high standing of the diaphragm in the supine position. Patients with orthopnea need to place several pillows under their heads. If the head moves off the pillows, patients wake up with shortness of breath and coughing. The feeling of shortness of breath is usually relieved by sitting, as this decreases venous return and reduces pulmonary capillary pressure. According to many patients, they feel better when they sit in front of an open window.

With severe chronic left ventricular failure, some patients cannot lie down at all and spend the whole night sitting, while in others the symptoms of pulmonary congestion weaken over time due to the addition of right ventricular failure.

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Orthopnea

1. Small medical encyclopedia. - M.: Medical encyclopedia. 1991-96 2. First aid. - M.: Great Russian Encyclopedia. 1994 3. Encyclopedic Dictionary of Medical Terms. - M.: Soviet Encyclopedia. - 1982-1984

See what “Orthopnea” is in other dictionaries:

orthopnea - noun, number of synonyms: 1 shortness of breath (10) ASIS Dictionary of Synonyms. V.N. Trishin. 2013 ... Dictionary of synonyms

orthopnea - (orthopnoe; ortho + Greek breathing) a forced sitting position taken by the patient to facilitate breathing with severe shortness of breath ... Big medical dictionary

ORTHOPNEA - (from the Greek orthos direct and pnoo breathing), the highest degree of shortness of breath that occurs with circulatory failure ... Veterinary encyclopedic dictionary

ORTHOPNEA - (orthopnoea) difficulty breathing in a lying position, forcing a person to sleep in a semi-sitting position in bed or sitting on a chair. Orthopnoeic ... Explanatory Dictionary of Medicine

Orthopnea (Orthopnoea) is difficulty breathing in a lying position, forcing a person to sleep in a semi-sitting position in bed or sitting on a chair. Orthopnoeic. Source: Medical Dictionary ... Medical Terms

Shortness of breath - I Shortness of breath (dyspnoe) is a violation of the frequency, depth or rhythm of breathing or a pathological increase in the work of the respiratory muscles due to an obstacle to exhalation or inhalation, accompanied, as a rule, by subjectively painful sensations of lack of air, ... ... Medical Encyclopedia

Bronchial asthma - Various inhalers used for bronchial asthma ... Wikipedia

Myocarditis - I Myocarditis Myocarditis (myocarditis; Greek + myos muscle + kardia heart + itis) is a term that unites a large group of different etiologies and pathogenesis of myocardial lesions, the basis and leading characteristic of which is inflammation. Secondary... ... Medical encyclopedia

Hypertensive crises are vascular crises in patients with hypertension, most often developing in the form of acute disorders of cerebral hemodynamics or acute heart failure against the background of a pathological increase in blood pressure. There are several... ... Medical encyclopedia

Heart failure - I Heart failure is a pathological condition caused by the inability of the heart to provide adequate blood supply to organs and tissues during exercise, and in more severe cases, at rest. In the classification adopted at the XII Congress... ... Medical Encyclopedia

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Medical Encyclopedia - Orthopnea

Related dictionaries

Orthopnea

Orthopnea is severe shortness of breath associated with stagnation in the pulmonary circulation, in which the patient cannot lie down and is forced to sit. When sitting, venous congestion moves to the lower extremities, while blood supply to the small circle decreases, heart function and gas exchange are facilitated, and oxygen starvation is reduced. The head end of the patient's bed should be elevated or the patient needs a chair.

Orthopnea (orthopnoe; from the Greek orthos - standing up, rising and pnoe - breathing) is the highest degree of shortness of breath, in which the patient cannot lie down and takes a forced sitting position. Orthopnea depends on circulatory failure, and the more pronounced the decompensation, the more vertical position occupied by the patient. Sometimes it is enough to raise the head end of the bed and the patient’s condition improves; in other cases, the patient is forced to sit in a chair around the clock. Orthopnea most often occurs with the development of left ventricular failure due to heart defects, coronary artery sclerosis, etc.

The body position during O. creates more favorable conditions for blood circulation in patients with heart damage: venous congestion in the area of ​​the lower extremities and portal vein leads to a decrease in blood flow to the heart and blood supply to the vessels of the small circle; the lumen of the alveoli increases, which leads to an increase in the vital capacity of the lungs.

Improved gas exchange in the lungs with O. is also achieved due to the more active participation of the diaphragm and respiratory muscles in the act of breathing. Reducing pulmonary congestion reduces reflex stimulation of the respiratory center, and improving gas exchange in the lungs to a certain extent reduces oxygen starvation of body tissues, including the myocardium, which improves the contractility of the heart and reduces shortness of breath. In addition, orthopnea reduces cerebral venous congestion, thereby facilitating the functioning of the circulatory and respiratory centers.

Orthopnea what is it

Acute difficulty breathing, cough, foamy, blood-stained (pink) sputum.

Collapse, cardiac arrest or shock.

Associated symptoms may be a reflection of the disease causing pulmonary edema

• Chest pain, palpitations: IHD/AMI, arrhythmia.
• Previous episodes of dyspnea on exertion: ischemic heart disease, left ventricular dysfunction.
• Oliguria, hematuria: acute renal failure.
• Convulsions, symptoms of intracranial hemorrhage.

The diagnosis of “pulmonary edema” or “heart failure” should not sound isolated. To carry out targeted therapy, it is also necessary to take into account the reasons that led to the development of this condition.

In many diseases, a combination of these factors is noted (for example, pneumonia, hypoxia, myocardial ischemia).

In the capillaries of the lungs, as in the systemic capillaries, the filtration rate is determined by the effective filtration pressure.

Pathology of the lymphatic system also contributes to the development of pulmonary edema. Normally, excess intercellular fluid is removed through the lymphatic vessels. However, even in normal conditions The capacity of the lymphatic system is extremely small. If right ventricular failure develops against the background of left ventricular failure, systemic venous pressure, and therefore the pressure in the lymphatic vessels, increases, which impairs the outflow of lymph.

A decrease in plasma protein concentration is observed when the protein-synthesizing function of the liver is impaired (liver failure) or protein loss, for example, through the kidneys (nephrotic syndrome).

Finally, pulmonary edema can develop as a result of increased capillary permeability. As a result, the oncotic pressure gradient decreases and the effective filtration pressure increases. Inhalation of poisonous gases or prolonged inhalation of oxygen also increases capillary permeability.

As a result of congestion in the lungs, their perfusion and, as a result, the maximum consumption of O 2 deteriorates. Dilatation of congestive vessels limits the distensibility of the alveoli and reduces the compliance of the lungs. In addition, dilated vessels compress the bronchi, increasing resistance to air flow, which is manifested by a decrease in maximum respiratory volume and FEV.

With interstitial edema, the space between the capillaries and alveoli increases. As a result, the diffusion of gases is disrupted, with the most pronounced changes affecting the absorption of O 2. If, during physical activity, oxygen consumption by tissues increases, then its concentration in the blood correspondingly decreases (hypoxemia, cyanosis).

Any subsequent increase in pressure and damage to the alveolar wall causes extravasation of fluid into the alveolar cavity. Fluid-filled alveoli are “switched off” from gas exchange, which leads to the formation of a functional arteriovenous shunt (interpulmonary artery and pulmonary vein) and a corresponding decrease in the concentration of O 2 in the systemic arterial blood (central cyanosis). Liquid penetrates into the respiratory tract, which, in addition to these changes, creates resistance to air flow.

Pulmonary edema forces the patient into an upright position (orthopnea). When changing from a horizontal to a vertical position, sitting or standing (orthostasis), venous return from the lower body decreases (more so if the patient stands up). Blood pressure in the right side of the heart and cardiac output of the right ventricle decrease. Decreased blood flow through the lungs causes a drop in hydrostatic pressure in the pulmonary capillaries while increased venous return to the lungs from the upper body. In addition, lowering central venous pressure improves lymphatic drainage in the lungs.

Differential diagnosis should first of all be carried out with an exacerbation (against the background of infection) of COPD (previous medical history, weakened breathing on auscultation with or without wheezing, a small amount of wheezing). Carrying out differential diagnosis with this condition based on clinical manifestations can be difficult.

If the patient's condition is severe (inability to speak, hypoxia, systolic blood pressure 90 mmHg and the patient does not have aortic valve stenosis:

• nitroglycerin spray is prescribed sublingually (2 doses);
• begin an intravenous infusion of nitroglycerin 1-10 mg/h, increasing the infusion rate every minute under blood pressure control.

When blood pressure decreases to 100 mm Hg. Possible combination with dopamine. However, the positive effect of these drugs can be offset by tachycardia and arterial hypotension against the background of systemic vasodilation. Phosphodiesterase inhibitors (enoxymone or milrinone) can be prescribed if dobutamine is ineffective.

Orthopnea what is it

Clinical examination of patients with heart failure begins with a history and objective examination, that are cornerstone in the clinical assessment of heart failure.

The main symptoms of heart failure are shortness of breath, inability to exercise, and fatigue. Although fatigue in heart failure is usually associated with reduced cardiac output, it can also be caused by skeletal muscle dysfunction and other noncardiac conditions. accompanying illnesses, such as anemia. At the initial stage of HF, shortness of breath is observed only during physical activity (PA), but as HF develops, it appears with less and less physical activity and is present even at rest.

The etiology of shortness of breath is multifactorial. Stagnation of blood in the lungs is the most important mechanism; it is accompanied by the accumulation of interstitial or intraalveolar fluid in the alveoli, which activates pericapillary J receptors and stimulates rapid shallow breathing, characteristic of cardiac dyspnea. Other factors that contribute to exertional dyspnea include impaired pulmonary compliance, increased airway resistance, fatigue of the respiratory muscles and/or diaphragm, and anemia.

When right ventricular failure and regurgitation occur tricuspid valve shortness of breath occurs less frequently.

Orthopnea in heart failure

Orthopnea is dyspnea that occurs in the supine position and is usually a late manifestation of heart failure compared to dyspnea during exercise. Orthopnea is usually relieved by sitting or using additional pillows during sleep. Orthopnea is considered as a consequence of the redistribution of fluid from the visceral circulation and from the lower extremities into the general circulatory bed in the supine position with a subsequent increase in pressure in the pulmonary capillaries.

This process is often accompanied by a cough, which is often a symptom of heart failure. Although orthopnea is a fairly specific symptom of heart failure, it can occur in patients with pulmonary disease, with concomitant obesity or ascites, or those whose respiratory mechanics require an upright posture.

Paroxysmal dyspnea during sleep is called acute attacks severe shortness of breath and cough, usually occurring in the patient while he is sleeping and interrupting his sleep, usually 1-3 hours after falling asleep. Evidence of paroxysmal sleep dyspnea may include coughing or wheezing, possibly due to high blood pressure in the bronchial arteries, leading to compression of the airways, and also due to interstitial pulmonary edema, creating increased airway resistance.

In patients with paroxysmal sleep dyspnea, coughing and wheezing often continue even when sitting on the edge of the bed with their legs down. Paroxysmal sleep dyspnea - quite specific symptom SN. Cardiac asthma is closely associated with paroxysmal sleep dyspnea. It is characterized by wheezing against the background of bronchospasm; it should be distinguished from primary asthma and wheezing of pulmonary etiology.

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Shortness of breath as a symptom of serious cardiovascular diseases

Dyspnea refers to breathing disorders (rhythm, frequency, depth) in which a person lacks air or has difficulty breathing.

Shortness of breath occurs with many ailments: diseases of the lungs, heart, autonomic or nervous disorders, anemia.

Breathing during shortness of breath is frequent, but inadequate, because the person is not able to take a deep breath and feels tightness in the chest with every breath.

Shortness of breath is not a diagnosis itself, but only an indicator (sign) of a disease. In heart disease, shortness of breath is an important symptom, which we will discuss below.

1. Reasons

Shortness of breath is usually associated with low content oxygen in the body (hypoxia) or in the blood (hypoxemia) and high levels of carbon dioxide. This causes reflex irritation of the respiratory center in the brain. As a result, a person feels a lack of air, which causes increased breathing.

With the restrictive form of shortness of breath, patients' lung volume is reduced. This may not be reflected in any way while it is at rest. As soon as such a person increases the load, shortness of breath appears. This is typical for people with pleural thickening or chest wall deformity.

In obstructive dyspnea, the narrowness of the airways leads to increased airflow resistance. Air enters the lungs normally when inhaled, but has difficulty leaving them.

For this reason, exhalation is difficult for such people. Such shortness of breath accompanies cardiac asthma, when fluid in the lungs leads to narrow airways and the inability to breathe normally.

With circulatory dyspnea, the body suddenly experiences a lack of oxygen. This kind of shortness of breath occurs with anemia.

Paroxysmal shortness of breath usually occurs suddenly at night. A person has to stand up suddenly to stop suffocating and start breathing.

We talk about inspiratory dyspnea when the patient’s breathing is impaired, and about expiratory dyspnea when it is more difficult for him to exhale.

Even healthy people may occasionally experience symptoms of shortness of breath. This happens against a background of anxiety and a decrease in the amount of carbon dioxide in the blood.

This condition is medically called hyperventilation syndrome. Shortness of breath can normally occur during physical activity, when the body’s need for oxygen is too great.

2. Shortness of breath due to various ailments

Dyspnea occurs in various pathologies. Most often these can be diseases of the lungs, heart, endocrine disorders, anemia, etc.

Shortness of breath due to obstructive processes in the respiratory organs usually manifests itself along with the symptoms of bronchitis (acute and chronic) and bronchial asthma.

Dyspnea with restrictive disorders occurs with pneumonia, exudative pleurisy, many serious diffuse lung diseases (pneumosclerosis, tuberculosis, granulomatosis, dust lung diseases), after chest surgery, with kyphoscoliosis and pneumothorax.

Dyspnea of ​​central origin (when the excitability of the respiratory center is reduced) occurs with dissociated breathing. In this case, the coordination of the muscles of the diaphragm and the respiratory muscles is disrupted, as a result of which breathing becomes wave-like.

This happens in some severe pathologies (circulatory disorders in the brain, abscess or inflammation of the brain).

Shortness of breath due to the accumulation of toxins (for example, acetone) is manifested by rare, noisy and deep breathing. This type of shortness of breath develops in diseases with impaired tissue respiration or blood transport function. Such pathological breathing occurs in diabetic coma, ketoacidosis, and renal failure.

3. For cardiac pathology

In heart disease, shortness of breath occurs due to excess blood (plethora) in the lungs and deterioration of cardiac output.

Shortness of breath in heart disease occurs due to stagnation of blood circulation and appears first during exercise, and then in a calm state, in the form of various breathing disorders and is combined with other manifestations of the disease (swelling, pain, rhythm pathology, etc.)

Shortness of breath can occur in the following manifestations:

• under load;
• at rest;
• in the form of attacks (up to pulmonary edema).

4. Under load

Of course, even healthy man may begin to choke when performing unusual physical activity (for example, running up to the tenth floor). But this is not considered a pathology.

If a person previously coped with the load, and then stopped, then this is pathological shortness of breath. This indicates that the person has heart problems and needs urgent consultation with a cardiologist.

5. The nature of shortness of breath in heart pathologies

Shortness of breath indicates congestion in the cardiovascular system. Often it appears after other symptoms already when the process has become advanced. And if the patient could ignore pain or swelling, then shortness of breath is too obvious a manifestation to be overlooked.

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In the news (tyts) symptoms of heart disease.

Orthopnea

With heart disease, shortness of breath may occur when lying down (orthopnea). It disappears after a person sits down or stands up. This indicates advanced cardiac pathology in humans.

Such people are often afraid to lie down and even sleep sitting up. The same fact explains the well-known feature of American President Franklin Roosevelt, who preferred to sleep in a chair.

Intense shortness of breath

In severe cases, patients with heart failure suffer from cardiac asthma or paroxysmal nocturnal dyspnea. Attacks of intense shortness of breath often occur at night, but the vertical position does not lead to relief of their condition, as occurs with orthostatic shortness of breath.

Such shortness of breath increases over time, and is accompanied by a cough with the appearance of foamy sputum. During such an attack, a person becomes agitated and is haunted by the fear of death.

Cardiac asthma is accompanied by severe weakness, anxiety, bluish skin, and the appearance of cold sticky sweat. An attack of cardiac asthma threatens the patient’s life, so such a person needs urgent hospitalization.

Shortness of breath in various pathologies of the cardiovascular system

Shortness of breath in various cardiac pathologies has its own characteristics, which are useful to know in order to act correctly.

In addition to shortness of breath, cardiac pathologies have the following symptoms:

• with chest pain, cold sticky sweat, a feeling of fear, sharp decline pressure - during myocardial infarction;
• with attacks of suffocation - with dissection of the thoracic aorta or severe blood loss;
• with heart rhythm disturbances - with paroxysmal tachycardia;
• sudden shortness of breath during physical activity - with an aortic aneurysm;
• with low blood pressure, sticky sweat, blue skin, severe pain in the heart, a sharp deterioration in health, occasionally loss of consciousness - with rupture of an aortic aneurysm or deep vein thromboembolism;
• with sudden wheezing, coughing, bluish skin - with pulmonary edema;
• simultaneous shortness of breath and pain in the heart, increasing with exercise - with damage to the coronary vessels of the heart.

6. Diagnostics

Since shortness of breath is not a disease, but only one of the symptoms, a patient with shortness of breath is examined comprehensively in a hospital setting.

When diagnosing, the doctor takes into account the patient’s medical history and all the symptoms accompanying shortness of breath.

Laboratory (blood and urine tests) and instrumental studies are carried out (x-ray, ECG, echocardiography, fluorography, computed tomography, blood sampling for tumor markers, cytological examination sputum, bronchoscopy).

7. Treatment

In case of cardiovascular diseases, shortness of breath is treated by a cardiologist.

Drugs for shortness of breath should be selected taking into account the disease.

If a patient has angina pectoris, then he needs urgent help at home.

To do this, the following procedure is performed:

• do not panic;
• urgently call an ambulance;
• provide a flow of fresh air;
• lay down or make the patient sit down;
• unfasten the buttons, belt on clothes, give an oxygen bag or breathing mask:
• give a nitrosorbide tablet under the tongue:
• Give a diuretic (Lasix, furosemide):
• if shortness of breath is psychogenic, give a sedative (valerian, tazepam, relanium, etc.)

It is necessary to warn patients and their relatives and friends about self-treatment of shortness of breath using traditional medicine. Such self-medication in this case will destroy the patient. Ill-spent time can lead to the death of a person who could have been saved.

If shortness of breath occurs occasionally, due to nervous overload, you can advise the patient to take decoctions of soothing herbs (lemon balm, valerian, motherwort, mint).

8. Prevention

Cardiac pathology is one of the most dangerous to human life. The main thing here is adequate treatment of the underlying disease, often lifelong.

In addition, it is recommended to keep correct image life, quit smoking and excessive drinking of alcohol, avoid constant stress, strengthen the immune system. Excess weight also complicates the course of heart disease and contributes to the appearance of shortness of breath.

Therefore, until the disease has become advanced, the patient should not avoid physical therapy classes, not be lazy about walking, and, if possible, visit the pool. Heavy physical activity is contraindicated for people with heart pathologies.

If heart disease already exists, it must be treated professionally, avoiding the development of complications in the form of acute conditions and shortness of breath. The disease cannot be neglected, otherwise it can lead to complete disability or death for the patient.

9. Forecast

The prognosis for this symptom is entirely related to the underlying disease and its course. The patient’s lifestyle and his attitude towards his health are also important.

Unfortunately, many heart diseases remain for the patient’s entire life and tend to worsen (angina pectoris, heart disease, arrhythmias, etc.)

In severe heart failure, the disease requires constant treatment, but even this cannot overcome shortness of breath, which is chronic.

10. Conclusions

Shortness of breath is a formidable symptom and cannot be ignored if we do not want trouble for ourselves or our loved ones.

It is important to know the following facts about it:

1. Shortness of breath manifests itself as a feeling.
2. It is not the disease itself, but speaks of its presence; the appearance of shortness of breath indicates that the disease is severe.
3. With heart disease, shortness of breath occurs against the background of other, pre-existing disorders that a person may not have noticed.
4. For any type of shortness of breath, the patient should immediately consult a doctor for advice.
5. Prevention is the correct and timely treatment of the disease that led to shortness of breath in the patient.
6. The prognosis depends directly on the patient’s underlying disease.

Dear readers, we urge you never to neglect taking care of your health, because life is beautiful only when we and our loved ones are healthy. And breathing well is also living well.