By Ragavendra R. Baliga MD MBA FRCP FACC, Kim A. Eagle
Completely up to date to mirror present American university of Cardiology/American middle organization directions, this concise but entire guide offers sensible details at the universal cardiovascular difficulties that clinicians come across day-by-day. The e-book presents a ordinary, authoritative advisor to assessment of universal cardiovascular indicators and assessment and administration of universal cardiovascular stipulations. insurance additionally comprises medical demanding situations akin to administration of power anticoagulation, assessing and minimizing cardiac chance in noncardiac surgical procedure, and administration of the cardiac surgical procedure sufferer. various tables and algorithms aid readers locate info quick and reduction in medical decision-making.
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Additional resources for Practical Cardiology Evaluation and Treatment of Common Cardiovascular Disorders
Example text
I feel a hunger for more air. I feel out of breath. I cannot get enough air. I am gasping for breath. COPD My breathing requires more work. I feel a hunger for more air. I feel out of breath. I cannot get enough air. I am gasping for breath. My breathing does not go out all the way. Asthma My breathing requires effort. I feel out of breath. My breathing requires work I am gasping for breath. My breathing is shallow. Interstitial lung disease My breathing requires effort. My breathing is heavy. I feel a hunger for more air.
Vocal cord paralysis, tracheal stenosis, endobronchial tumor), result in dyspnea. Increased work of breathing is typically noted in these conditions. Heterogeneous reduction of airflow, when present, results in regional ventilation/perfusion mismatching, with consequent hypoxemia and increased ventilatory requirements. However, ventilatory muscle fatigue and air trapping reduce ventilatory capacity. 1. Pathophysiologic framework for chronic dyspnea, with specific examples CATEGORY EXAMPLE Impaired cardiovascular function Myocardial disease Systolic dysfunction Ischemic cardiomyopathy Nonischemic cardiomyopathies Diastolic dysfunction Hypertensive heart disease Coronary artery disease Hypertrophic cardiomyopathy Restrictive cardiomyopathy Valvular disease Aortic or mitral regurgitation Aortic or mitral stenosis Pericardial disease Constrictive pericarditis Pulmonary vascular disease Pulmonary thromboembolism Primary pulmonary hypertension Congenital anomalies Cyanotic heart diseases (right-to-left shunts) Impaired pulmonary function Airflow obstruction Diffuse Asthma 30 31 COPD Focal Vocal cord dysfunction or paralysis Tracheal stenosis Endobronchial tumor Restriction of lung mechanics Interstitial lung disease Idiopathic pulmonary fibrosis Pneumoconioses Lymphangitic carcinomatosis Extrapulmonary thoracic restriction Kyphoscoliosis Pleural effusion or fibrosis Neuromuscular weakness Phrenic nerve paralysis Spinal cord injury Amyotrophic lateral sclerosis Abnormal gas exchange Abnormal alveoli/capillary interface Eosinophilic pneumonia Right to left shunting Pulmonary arteriovenous malformations Altered central ventilatory drive or perception Systemic or metabolic disorders Increased metabolic requirements Hyperthyroidism Obesity Decreased oxygen-carrying capacity Anemias Metabolic acidosis Renal failure Mitochondrial myopathies Direct stimulation of respiratory center Aspirin or ethylene glycol overdose Physiologic processes causing dyspnea Vigorous exercise Pregnancy Hypoxic breathing at high altitude Deconditioning COPD; chronic obstructive pulmonary disease.
The diagnosis of airflow obstruction is confirmed by a decreased ratio of forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC). Once a diagnosis of airflow obstruction is made, no further diagnostic evaluation is immediately warranted. During a therapeutic course for obstructive lung disease, further spirometric testing is helpful for assessing response to treatment. If dyspnea persists despite response to therapy, or if no objective response to therapy occurs, then further diagnostic evaluation is required.
