Shortness of breath is a violation of frequency, rhythm or breathing depth, accompanied, as a rule, the feeling of lack of air.
If the nervous regulation of breathing is not broken, shortness of breath has a compensatory value (it is aimed lack of oxygen and the excretion of excess carbon dioxide). Breath - complex reflex act, which involves: the cerebral cortex, respiratory center, spinal nerves, muscles of the chest, diaphragm, lungs, the cardiovascular system and blood transporting gases. Clinical symptoms of dyspnea depend on the link, which has developed violations.
Shortness of breath Central type associated with the disorder cortical regulation of breath or primary lesions of the respiratory centre. Neuroses (often hysterical) is characterized by shortness of breath very superficial breath with a sharp tachypnea (see) - sometimes up to 50-70 breaths in 1 min. ("dog breath"). The task assistant to reassure the patient, to switch his focus to try to make you hold your breath, then breathe deeply and slowly. At the same time give sedatives: Valerian tincture (1 teaspoon on 30 g of water), till 0.5 g orally, injected, pipolfen 2 ml of 2.5% solution intramuscularly.
The defeat of the respiratory centre, especially when poison pills or drugs, usually manifested by respiratory depression (a decrease in the depth and frequency) and a violation of its rhythm (see the Breath). In these cases we use products, stimulating the respiratory center,- kordiamin 5 ml intravenously, caffeine-benzoate sodium 2 ml of 20% solution subcutaneously or aminophylline 10 ml of 2.4% solution with 10 ml of 40% glucose solution intravenously.
For reducing the volume of breath due to violations mobility of the diaphragm or chest (flatulence, kyphoscoliosis, chest pain, etc.,) or the filling liquid of the pleural cavity (for example, hydrothorax), with exercise is developing rapidly tachypnea. Diagnostics help the characteristics of the main process (distended abdomen, kyphoscoliosis, and so on). Treatment is aimed at eliminating the causes - biopsy of the pleura when hydrothorax, gas discharge tube with flatulence, etc.
Pulmonary shortness of breath may be associated with a decrease in surface and insufficient compliance (restriction) of the lung tissue, reducing bronchial obstruction (obstruction) or a violation of diffusion of gases in the alveoli. Restrictive type of apnea (usually when pnevmoskleros) is characterized by difficulty breath (inspiratory wheeze) and short breath. As reduced lung capacity (see), the boundaries of the lungs are high, the depth of inhalation limited. In the lungs often heard wheezing.
Diffusion failure of the lungs, often combined with restricitive process (pnevmoskleros), characterized by sharply shortness of breath with tachypnea and pronounced "black" cyanosis (see) of the skin and mucous membranes. Shortness of breath and cyanosis increase markedly at the slightest physical activity. The treatment should be aimed at addressing the causes of dyspnea.
The most frequently pulmonary shortness of breath associated with the violation of bronchial obstruction due to spasm of the bronchi, swelling or clogged with mucus. Since the degree of bronchial obstruction volatile, shortness of breath expressed differently in different days, sometimes disappears completely, sometimes reaches the degree of suffocation. Characterized by long and difficult exhale (expiratory dyspnea), swelling on the exhale neck veins (because of increase of pressure in the chest cavity) and the signs of emphysema (see). The majority of patients with such shortness of breath, unlike patients with heart shortness of breath might lie low in bed; limb is usually warm. In bronchial asthma (see) in the lungs heard whistling dry rales on the exhale, sometimes heard in the distance.
Treatment - bronchodilating agents: ephedrine 0,025 g, or belladonna 0.015 g inside, or teofedrin 1/2-1 tablet inside, or aminophylline 1 ml of 24% solution intramuscularly (individual selection of medications and doses); difficulty phlegm - expectorants (see).
Heart shortness of breath develops due to failure left heart, manifested or low cardiac output, or congestion in the lungs, or a combination of both. With a low heart ejection broken the power of the brain, therefore, shortness of breath corresponds clinically shortness of breath Central type, but increases in physical activity. The stagnation of blood in the pulmonary veins violates the gas exchange and conditions ventilation. In such cases, the frequency and depth of breathing increases, there comes the orthopnea (see). Such shortness of breath may occur in the night (see Cardiac asthma), but more often after exercise. Heart shortness of breath is often combined with swelling and acrocyanosis (see), cold extremities. In the lungs often listens fine bubble and srednepuzyrchatye wheezing, and the development of pulmonary edema - and large bubble. Because of the variety of mechanisms that form the heart shortness of breath, treatment should be complex, including drugs, digitalis, diuretics are prescribed. In urgent cases, the medical officer should give the patient poluciaetsea position, to soothe him, to give sedatives (as for shortness of breath Central type), oxygen; enter veins slowly 0.5 ml of 0.05% solution strofantina with 10 ml of 40% glucose solution (if the patient did not receive the drug digitalis!), to give 50 mg gipotiazida or 40 mg of lasixa inside.
Hematogenous shortness of breath caused by the effect on the respiratory center acidic substances in the acidosis or products violated exchange (for example, in case of insufficiency of kidney or liver). Acidosis causes large increases in the frequency and depth of breathing (polynoe). In serious cases (for example, in diabetic coma) breathing becomes noisy (big and noisy breathing, Kussmaul"). Treatment is to fight acidosis (see the Revival of the body).
Often in patients suffering from heart and lung diseases, pathogenesis apnea often mixed (e.g., heart shortness of breath may be complicated by a decrease in respiratory excursions through flatulence, abdominal dropsy or "panic breathing" due to cerebral hypoxia and so on). Therefore, the treatment should take into account the characteristics and types of breathlessness that a particular patient are not leading.
Shortness of breath (dyspnea; from the Greek. dyspnoia - shortness of breath) - the feeling of breathing difficulties, objectively accompanied by changes its frequency, depth and rhythm.
Shortness of breath usually has a compensatory character and is caused by necessity to keep the gas composition of blood. Healthy people shortness of breath may occur if the physical work, when the blood accumulated in excessive amounts of non-completely oxidized products of metabolism and develops the physiological condition of oxygen debt. This raises a sense of fatigue, a feeling of shortness of breath, rapid breathing. In such cases, O. becomes important physiological protective mechanism, warning overloading of the body. Protective role of O. this descent becomes clear if we consider that breathing is regulated by the Central nervous system. Respiratory center reflex responds to constantly receive extero - and interoceptive impulses and humoral influence, coming to him in connection with this or that state of metabolic processes in the body.
Often respiratory disorders are not accompanied by a feeling of lack of air. These conditions may occur with rapid rise on height, with a lack of oxygen during operation in respiratory apparatus, in case of poisoning by carbon monoxide, etc., In such cases, there is a very rapid breathing, however unpleasant feeling of lack of air can be absent.
Shortness of breath occurs when a number of diseases and clinical symptom is of great diagnostic and prognostic value. When some hard place diseases are observed special breathing with a characteristic alteration of his rhythm breath Biota and Cheyne - Stokes equations. When bytowska breath separate deep respiratory movements are replaced by long pauses. For breathing Cheyne - Stokes equations characterized by the change of the periods of increase of the depth and frequency of respiratory movements periods of their gradual reduction to temporarily stop breathing (apnea), sometimes lasted for 10-30 seconds.
Depending on the causes, mechanisms of development and clinical manifestations can be distinguished shortness of breath cardiac, pulmonary, cardio-respiratory, cerebral and hematogenous.
Heart shortness of breath. Early on, circulatory failure, he irritates the respiratory center, increased pulmonary ventilation, soon Acting in connection with the physical stress and eating. With the development of heart failure (mitral stenosis, cardiosclerosis, and others) is insufficient saturation of blood with oxygen, reduces the partial pressure O2 and increases the content of CO2 in the blood, decreases the minute volume of blood, tissue hypoxia occurs. Oxygen debts in case of insufficiency of blood circulation is notably high only at advanced stages of the disease.
Hemodynamic changes and the chemistry of the blood leads to reflex irritation Baro - and chemoreceptors in sinocarotidna and aortic areas, pulmonary vascular network, hollow vein, the Atria. Eventually there comes a change in the functional state of respiratory center, there is shortness of breath. Most often brightly and shortness of breath expressed in patients with mitral stenosis. This is due to the increase of pressure in the pulmonary artery and stagnant phenomena in small circulation.
Pulmonary shortness of breath occurs at various disorders of the respiratory system. Heavy O. and choking developed when the effects on the mucous membrane of the respiratory tract irritant gases (chlorine, ammonia and other). In case of poisoning S a slow-acting type of phosgene early sign of intoxication is gradually increasing frequency of breathing, the feeling of lack of air and anxiety. If you experience swelling of the lungs growing phenomenon of violations of gas exchange, enhanced O. and cyanosis.
Shortness of breath is often found in acute pneumonia. Surface and rapid breathing when this is connected with reduction of volume of functioning of the lung tissue and the irritating effects of the inflammatory process on the afferent endings of the vagus nerve, which leads to a reduction in the threshold of the respiratory reflex. Acting for pneumonia depends on effect on the respiratory center of toxic products which enter the blood stream from the source of inflammation, increased body temperature, etc.
Shortness of breath pleurisy occurs because of changes in the mechanical and aerodynamic factors of external respiration. Have also a value disorders pulmonary component of the respiratory reflex, changes of blood gas composition.
Severe shortness of breath and choking when embolism pulmonary vessels are accompanied by a sense of instinctive fear, pain in the heart area with the appropriate irradiation and circulatory disorders, simulating sometimes myocardial infarction. Sudden onset of severe OA can serve as an early differential-diagnostic sign of blockage of the branches of the pulmonary artery.
Inspiratory dyspnea (shortness of breath) occurs when reflex spasm of the glottis. Appearing at this apnea is followed by a feeling of fear; a noisy breath, the breath participate auxiliary muscles. When edema of the glottis toxicoinfections or allergic nature heavy O. develops quickly.
In case of compression of the trachea tumor shortness of breath develops gradually. The reason inspiratory apnea is a mechanical irritation of proprioception lungs, intercostals muscles and diaphragm forced breath. At elimination of obstacles (tracheotomy, removal of the tumor) Acting immediately disappears.
Expiratory O. (difficulty exhalation) occurs when the narrowing of the lumen of the small bronchi and bronchioles due to spasm of the bronchial muscles, inflammatory or allergic swelling of the mucous membrane of the bronchi. Expiratory O. usually observed in bronchial asthma. During the attack the patient takes sitting position, leaning his arms on the bed, which promotes the involvement in breathing act auxiliary muscles. Develop phenomena acute swelling of the lungs, the lower boundary of light falls and loses mobility, intercostal spaces are smoothed out. Percussion is determined pulmonary sound with tympanic shade.
Cardiopulmonary shortness of breath occurs in severe forms of bronchial asthma and emphysema. Associated with such conditions sclerotic changes in the pulmonary artery lead to increased pressure in the pulmonary circulation, hypertrophy of the right heart and disturbances of hemodynamics.
Cerebral shortness of breath occurs due to the direct irritation of the respiratory center. Shortness of breath that may occur in organic affection of the brain in the region of the respiratory center (skull injury, tumors, parasitic brain damage, haemorrhage and thrombosis of cerebral vessels, inflammation and swelling of the brain). Changes breathing can be very diverse. So, abscesses of the brain are often accompanied by significant decrease of breath, in hemorrhages in the brain stem can be observed periodic breathing (see the Breath pathological). Cerebral O. may occur with functional disorders of the nervous system. O. respiratory neurosis, hysteria is very rapid and shallow breathing.
In infectious diseases shortness of breath is the result of reflex and the direct effect on the respiratory center of toxic products, allocated by the pathogen of the disease, and high temperature.
In the anoxic conditions there are various forms of O. depending on the degree of hypoxia, speed of onset and duration of its validity respiratory disorders can be very diverse in nature. During the gradual development of hypoxia deep and fast breathing then becomes superficial and more frequent. Later comes the decrease of respiratory movements appear periodic forms of breath (wave-like breathing, the breathing type Chein - Stokes equations, Biota), then you may experience convulsive atonal respiratory movements, changing by respiratory paralysis.
In the pathogenesis of these forms of respiratory distress, along with direct violation of the functions of the respiratory center is an important role for violations of activity of higher education of the brain.
Hematogenous shortness of breath caused by changes in the chemistry of the blood. Hypercapnia and acidosis usually lead to a significant deepening and increased respiration, and accumulation of toxic metabolic products (diabetic coma, uremia, anemia and other). In diabetic coma and there has been a big breath" Kussmaul (deep noisy breaths). Hypoxemia is mainly characterized by the increased frequency of respiratory movements. When significant hypoxemia may receive periodic form of breathing.
To hematogenous shortness of breath can be attributed O. when exogenous intoxication (poisoning, morphine, alcohol, drugs and narcotics, nicotine, and others). Form O. if poisoning is primarily determined by the characteristics of a toxic agent and can change in wide limits.