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DyspneaDyspneaI.DefinitionI.DefinitionSubjectiveAwarenessofdifficultybreathing;shortnessofbreathObjectiveExpression:toilfulbreathingaction(withnosewinginhalingandfurling,mouthopen,shouldershunching,faceturningdarkpurple,andaccessorymusclesofrespirationparticipatingintheaction),abnormalfrequency,depthandrhythmofbreath.respiratoryrespiratoryPhysiologyPhysiologyThefullprocessofrespirationcomprisesExternalrespiration——trachea,alveolus,thoraxTransportofairthroughblood——arterybloodoxygenInternalrespiration——gaspressure,solubility,dispersion,V/QDyspneamayoccurasresultofphysiologicalorpathologicalchangeofanyofthethreeprocessesdescribedabove.II.II.Etiology1.Respiratorysystemdiseases2.Cardio-vascularsystemdiseases3.Toxication4.Hemopathy5.Neuralandmentalfactors1.Respiratorysystemdiseases–Obstruction:asthma,COPD,tumor–PulmoDiseases:pneumonia,interstitiallungdisease,–Chestwallorpleura:pleurisy,pneumothorax,trauma–neuro-muscles:poliomyelitis(脊髓灰质炎),myastheniagravis(重症肌无力)–Diaphragmamovementdisorder:obviouslyelevatedpressureinabdominalcavityEtiology2.Cardio-vascularsystemdiseases2.Cardio-vascularsystemdiseases1Heartfailure2pericardialtamponade3pulmonaryarteryhypertension4PulmonarythromboembolismEtiology3.Toxication3.Toxication1）Uraemia2）diabetesketoacidosis3）Drug-inducedtoxication:morphine,organicphosphor,nitrite,cyanide4）carbonmonoxidepoisoningEtiology4.Hemopathy4.Hemopathy1）seriousanemia2）High-iron-contenthemoglobin3）AbnormalhemoglobinEtiology5.Neuralandmentalfactors5.Neuralandmentalfactors1）Respiratorynervecenterobstacle,cranialtrauma,cerebralhemorrhage,cerebraltumor,encephalitisandmeningitis2）Mentalfactor:hysteriaEtiologyIII.III.MechanismandMechanismandClinicalfeatureofDyspneaClinicalfeatureofDyspnea1.Withpulmonaryorigin2.Withcardiacorigin3.Inducedbytoxication4.Inducedbyblood5.InducedbyneuralormentalfactorMechanismMechanism1）InhalationDyspnea:Characteristics/CommonPathogeny2）ExhalationDyspnea:Characteristics/CommonPathogeny3）MixedDyspnea:Characteristics/CommonPathogenyExpressionDyspneawithPulmonaryOriginRespiratoryDyspneaRespiratoryDyspneaInspiratorydyspnea____obstructioninlargeairway–Threedepressionsigndepressioninsuprasternalfossa,supraclavicularfossa,intercostalspaceExpiratorydyspnea____obstructioninsmallairwayoralveolarelasticitydecreased–Prolongedexpiratorytime–ExpiratoryrhonchiMixeddyspnea____deficientgasexchange–Respiratoryrateincreased–ShallowbreathingsupraclavicularfossaintercostalspacesuprasternalfossaThreedepressionsignCardiacdyspnea____Cardiacdyspnea____HeartfailureHeartfailureMechanismofleftheartfailurePulmoedemadiffusioncapacitydecreasedAlveolartensionincreasedstimulatingstretchreceptorexcitationofvagusnerveexcitationofrespiratorycenterAlveolarelasticitydecreasedvitalcapacitydecreasedIncreasedpressureofpulmocirculationstimulatingrespiratorycenterFeaturesofleftheartfailureFeaturesofleftheartfailureUnderlyingdiseasesMixeddyspneaPositionrelateddyspneaMoistcracklesorrhonchiinbothlungsReliefofsymptomsafterdigitalis,diuretic,vasodilatoragentusedNocturnalparoxysmaldyspneaNocturnalparoxysmaldyspneaCharacteristicsAwokenduetochesttightnessordyspneaForcedsittingpositionororthopneaSeveresweatTachycardiaMoistcracklesorrhonchiinbothlungsPinkfrothysputumNocturnalparoxysmaldyspneNocturnalparoxysmaldysp...