Manifestations of respiratory system dysfunctions M. Tatar, J. Hanacek

Cardinal respiratory symptoms and signs cough sputum dyspnea wheezing cyanosis chest discomfort chest pain

Disorders of lung mechanics

Disorders of the lung mechanics Airway obstruction –nasal cavity: nasal congestion –pharynx: collapse during sleep –larynx: suffocation –central aw: trachea: stridor main bronchi: dyspnea, wheezing lobar bronchi: asymptomatic or minor dyspnea –peripheral aw: dyspnea Lung parenchyma (  or  compliance): dyspnea Chest wall (abnormalities): dyspnea Respiratory muscles (fatigue): dyspnea

Disorders of airway defence mechanisms

Disorders of airways defence mechanisms Nasal cavity –sneezing –nasal dyscharge Airways –Cough: acute respiratory infections, foreign body aspiration, chronic bronchitis, chronic cough –Expectoration - Sputum mucoid (mainly macrophages) purulent (neutrophils) Pneumococcus - bloody or rust-colored Pseudomonas, Haemophilus - green sputum

Hyperplasia and hypertrophy of submucosal glands

Disorders of gas exchange

Respiratory insufficiency (failure) –Hypoxemic Decreased ventilation/perfusion ratio Venous admixture Diffusion impairment –Hypercapnic Overall alveolar hypoventilation Limits for hyperventilatory compensation of decreased ventilation/perfusion ratio

Vznik hypoxémie vplyvom zníženia V/Q pomeru ’

Kompenzačné mechanizmy pri hyperkapnii

Disturbed regulation of breathing Cheyne-Stokes respiration Sleep apnea Hyperventilation Gasping Hypopnea Shortness of breath

Cheyne-Stokes breathing

General body responses Fever Weakness, fatigue Decreased exercise tolerance Immunity: eosinophilia Weight loss: advanced disease

Cough Physiologic reflex Pathologic reflex Acute cough Chronic cough –Rhinitis/sinusitis –Asthma –Gastroesophageal reflux disease

Dyspnea Air hunger, chest tighness Subject´s feelings – needs for increased ventilatory activity Tachypnoea with either shallow or deep breathing Increased workload of respiratory muscles – normal gas exchange cannot be achieved without increased ventilatory effort

Pathophysiology of dyspnea Hyperventilation – acute hypoxemia Relative hyperventilation - decreased ventilatory surfice (atelectasis, pleural effusion, lung congestion, pneumotorax) Disordered lung mechanics (most frequent cause) - Upper airways stenosis - Increased arways resistence = obstruction of peripheral airways (asthma, COPD, heart failure) - Decreased muscle force (polyomyelitis, diaphragm paralysis, myastenia gravis) - Limited chest movements (kyphoscoliosis) -!!! acute or chronic state; rest or physical activity

Causes of dyspnea  oxygen content in atmosphere  oxygen consumption during physical activity Lung function disorders Heart function disorders Decreased hemoglobin content (during exercise) Respiratory center dysfunction (Cheyne-Stokes, acidosis) Stimulation of airway and lung nerve-endings (pneumonia, lung congestion) Obesity Emotive factors (chronic hyperventilatory syndrom) Brain dysorders Metabolic dysorders – hyperthyreosis

Hypoxemia Tachycardia, tachypnea, dyspnea, mental status changes Secondary polycythemia (  hematocrit) Cyanosis threshold for central cyanosis is a capillary reduced hemoglobin content of 5 g/dL !!! ancillary nonspecific signs

Relation between SaO 2 and arterial Hb

Cyanosis Central –hemiglobin – methemoglobin, sulphhemoglobin –hemoglobin -  content of reduced Hb Heart disorders – lung congestion Lung disorders –acute: pneumonia, lung edema –chronic: COPD, severe lung fibrosis Peripheral –local perfusion disorders False –pigmentation (silver)

Peripheral and central cyanosis Peripheral Central

Hypercapnia Morning headaches Papilledema, dilated conjunctival and superficial facial blood vessels CO 2 narcosis: anxiety may progress to delirium and somnolency

Primary respiratory disorders can significantly affect the function of other systems Most frequently CVS Cor pulmonale elevated jugular venous pulse, peripheral edema Massive pulmonary embolism and tension pneumothorax circulatory shock – hypotension, weakness, pale, sweaty, oliguric, and develops impaired mentation OSAS daytime sleepiness, right heart failure, systemic arterial hypertension