History. Is the dyspnoea acute or chronic?
Well, acute onset suggest infection or maybe
PE. So, imagine, let's say your patient
has, what sign is it? Haman sign in which
there is pain in the calf upon dorsiflexion.
This then indicate your patient may
have DVT. And whenever you have patient that has DVT,
that thrombus might then break off, may result
in a massive saddle embolus in which, what your
patient is doing? Rapid shallow breathing.
Acute onset of rapid shallow breathing, understand
your patient is still remaining hypoxic that
is important. Chronic is more consistent with
COPD or maybe perhaps interstitial lung disease
and we will get into that when we talk about
What about the dyspnoea? Well, does it occur
while doing something in particular? Was there
exposure that was taking place maybe to an
allergen and what not? And that will then
tell you what caused the dyspnoea in that
case. Dyspnoea with exertion, present before
dyspnoea at rest. Now, that is important for
understanding. That dyspnoea, did it occur
with increased exertion or did it occur at
rest? So therefore, you are thinking more
along the lines of maybe heart issues. If
it is also the heart and if there is dyspnoea
with lying down, this to you indicates orthopnea.
What does that mean? “Hey, doc, I bought
this lovely bed. I saved up all my money so
that I could then buy this for Christmas,
but now, I can’t even use the bed. In fact,
I have to sleep on my reclining chair." What
is this? Orthopnea. Why? If it is CHF, then
lying down, there is going to be increased
accumulation of fluid or edema in the lungs.
So therefore, you sit up, and so with that
angle, you will be able to drain some of that
fluid. It's called orthopnea.
Dyspnoea while standing. What’s this? Platypnea.
Common with AV malformations or hepatopulmonary
syndromes and by this we mean, that if the
individual’s AV malformations. For
example, say that you are moving from the
arteries and you don’t have your capillaries
and you moved into your veins. It's called
AV malformations. Now, that could be genetic
and when they are, imagine you are dyspnoea
even during standing because you are not able
to properly do what? Not properly have gas
exchange. That’s my problem because you
don’t have, take a look at the word A or
abbreviation, AVM. Arterial venous malformation.
What do you not see there? The capillaries.
But, you must have capillaries for proper
gas exchange. Spend a little bit of
time, make sure you know the positioning of