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Diagnose on Sight: Shortness of Breath

A case of traumatic shortness of breath from Sara Sifuentez, MD, Saleen Manternach, MD, Danielle Campagne, MD  
aliem.com
over 4 years ago
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AHA Releases First Scientific Statement on Acute MI in Women

The association reports that instead of a "Hollywood heart attack," more women than men present with atypical symptoms, such as shortness of breath, which can affect both diagnosis and treatment.  
medscape.com
over 4 years ago
Www.bmj
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Management of interstitial lung disease associated with connective tissue disease

The lung is a common site of complications of systemic connective tissue disease (CTD), and lung involvement can present in several ways. Interstitial lung disease (ILD) and pulmonary hypertension are the most common lung manifestations in CTD. Although it is generally thought that interstitial lung disease develops later on in CTD it is often the initial presentation (“lung dominant” CTD). ILD can be present in most types of CTD, including rheumatoid arthritis, scleroderma, systemic lupus erythematosus, polymyositis or dermatomyositis, Sjögren’s syndrome, and mixed connective tissue disease. Despite similarities in clinical and pathologic presentation, the prognosis and treatment of CTD associated ILD (CTD-ILD) can differ greatly from that of other forms of ILD, such as idiopathic pulmonary fibrosis. Pulmonary hypertension (PH) can present as a primary vasculopathy in pulmonary arterial hypertension or in association with ILD (PH-ILD). Therefore, detailed history, physical examination, targeted serologic testing, and, occasionally, lung biopsy are needed to diagnose CTD-ILD, whereas both non-invasive and invasive assessments of pulmonary hemodynamics are needed to diagnose pulmonary hypertension. Immunosuppression is the mainstay of treatment for ILD, although data from randomized controlled trials (RCTs) to support specific treatments are lacking. Furthermore, treatment strategies vary according to the clinical situation—for example, the treatment of a patient newly diagnosed as having CTD-ILD differs from that of someone with an acute exacerbation of the disease. Immunosuppression is indicated only in select cases of pulmonary arterial hypertension related to CTD; more commonly, selective pulmonary vasodilators are used. For both diseases, comorbidities such as sleep disordered breathing, symptoms of dyspnea, and cough should be evaluated and treated. Lung transplantation should be considered in patients with advanced disease but is not always feasible because of other manifestations of CTD and comorbidities. Clinical trials of novel therapies including immunosuppressive therapies are needed to inform best treatment strategies.  
feeds.bmj.com
over 4 years ago
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2

Management of interstitial lung disease associated with connective tissue disease

The lung is a common site of complications of systemic connective tissue disease (CTD), and lung involvement can present in several ways. Interstitial lung disease (ILD) and pulmonary hypertension are the most common lung manifestations in CTD. Although it is generally thought that interstitial lung disease develops later on in CTD it is often the initial presentation (“lung dominant” CTD). ILD can be present in most types of CTD, including rheumatoid arthritis, scleroderma, systemic lupus erythematosus, polymyositis or dermatomyositis, Sjögren’s syndrome, and mixed connective tissue disease. Despite similarities in clinical and pathologic presentation, the prognosis and treatment of CTD associated ILD (CTD-ILD) can differ greatly from that of other forms of ILD, such as idiopathic pulmonary fibrosis. Pulmonary hypertension (PH) can present as a primary vasculopathy in pulmonary arterial hypertension or in association with ILD (PH-ILD). Therefore, detailed history, physical examination, targeted serologic testing, and, occasionally, lung biopsy are needed to diagnose CTD-ILD, whereas both non-invasive and invasive assessments of pulmonary hemodynamics are needed to diagnose pulmonary hypertension. Immunosuppression is the mainstay of treatment for ILD, although data from randomized controlled trials (RCTs) to support specific treatments are lacking. Furthermore, treatment strategies vary according to the clinical situation—for example, the treatment of a patient newly diagnosed as having CTD-ILD differs from that of someone with an acute exacerbation of the disease. Immunosuppression is indicated only in select cases of pulmonary arterial hypertension related to CTD; more commonly, selective pulmonary vasodilators are used. For both diseases, comorbidities such as sleep disordered breathing, symptoms of dyspnea, and cough should be evaluated and treated. Lung transplantation should be considered in patients with advanced disease but is not always feasible because of other manifestations of CTD and comorbidities. Clinical trials of novel therapies including immunosuppressive therapies are needed to inform best treatment strategies.  
feeds.bmj.com
over 4 years ago
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0
0

Management of interstitial lung disease associated with connective tissue disease

The lung is a common site of complications of systemic connective tissue disease (CTD), and lung involvement can present in several ways. Interstitial lung disease (ILD) and pulmonary hypertension are the most common lung manifestations in CTD. Although it is generally thought that interstitial lung disease develops later on in CTD it is often the initial presentation (“lung dominant” CTD). ILD can be present in most types of CTD, including rheumatoid arthritis, scleroderma, systemic lupus erythematosus, polymyositis or dermatomyositis, Sjögren’s syndrome, and mixed connective tissue disease. Despite similarities in clinical and pathologic presentation, the prognosis and treatment of CTD associated ILD (CTD-ILD) can differ greatly from that of other forms of ILD, such as idiopathic pulmonary fibrosis. Pulmonary hypertension (PH) can present as a primary vasculopathy in pulmonary arterial hypertension or in association with ILD (PH-ILD). Therefore, detailed history, physical examination, targeted serologic testing, and, occasionally, lung biopsy are needed to diagnose CTD-ILD, whereas both non-invasive and invasive assessments of pulmonary hemodynamics are needed to diagnose pulmonary hypertension. Immunosuppression is the mainstay of treatment for ILD, although data from randomized controlled trials (RCTs) to support specific treatments are lacking. Furthermore, treatment strategies vary according to the clinical situation—for example, the treatment of a patient newly diagnosed as having CTD-ILD differs from that of someone with an acute exacerbation of the disease. Immunosuppression is indicated only in select cases of pulmonary arterial hypertension related to CTD; more commonly, selective pulmonary vasodilators are used. For both diseases, comorbidities such as sleep disordered breathing, symptoms of dyspnea, and cough should be evaluated and treated. Lung transplantation should be considered in patients with advanced disease but is not always feasible because of other manifestations of CTD and comorbidities. Clinical trials of novel therapies including immunosuppressive therapies are needed to inform best treatment strategies.  
feeds.bmj.com
over 4 years ago
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0
4

Management of interstitial lung disease associated with connective tissue disease

The lung is a common site of complications of systemic connective tissue disease (CTD), and lung involvement can present in several ways. Interstitial lung disease (ILD) and pulmonary hypertension are the most common lung manifestations in CTD. Although it is generally thought that interstitial lung disease develops later on in CTD it is often the initial presentation (“lung dominant” CTD). ILD can be present in most types of CTD, including rheumatoid arthritis, scleroderma, systemic lupus erythematosus, polymyositis or dermatomyositis, Sjögren’s syndrome, and mixed connective tissue disease. Despite similarities in clinical and pathologic presentation, the prognosis and treatment of CTD associated ILD (CTD-ILD) can differ greatly from that of other forms of ILD, such as idiopathic pulmonary fibrosis. Pulmonary hypertension (PH) can present as a primary vasculopathy in pulmonary arterial hypertension or in association with ILD (PH-ILD). Therefore, detailed history, physical examination, targeted serologic testing, and, occasionally, lung biopsy are needed to diagnose CTD-ILD, whereas both non-invasive and invasive assessments of pulmonary hemodynamics are needed to diagnose pulmonary hypertension. Immunosuppression is the mainstay of treatment for ILD, although data from randomized controlled trials (RCTs) to support specific treatments are lacking. Furthermore, treatment strategies vary according to the clinical situation—for example, the treatment of a patient newly diagnosed as having CTD-ILD differs from that of someone with an acute exacerbation of the disease. Immunosuppression is indicated only in select cases of pulmonary arterial hypertension related to CTD; more commonly, selective pulmonary vasodilators are used. For both diseases, comorbidities such as sleep disordered breathing, symptoms of dyspnea, and cough should be evaluated and treated. Lung transplantation should be considered in patients with advanced disease but is not always feasible because of other manifestations of CTD and comorbidities. Clinical trials of novel therapies including immunosuppressive therapies are needed to inform best treatment strategies.  
feeds.bmj.com
over 4 years ago
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0
9

Management of interstitial lung disease associated with connective tissue disease

The lung is a common site of complications of systemic connective tissue disease (CTD), and lung involvement can present in several ways. Interstitial lung disease (ILD) and pulmonary hypertension are the most common lung manifestations in CTD. Although it is generally thought that interstitial lung disease develops later on in CTD it is often the initial presentation (“lung dominant” CTD). ILD can be present in most types of CTD, including rheumatoid arthritis, scleroderma, systemic lupus erythematosus, polymyositis or dermatomyositis, Sjögren’s syndrome, and mixed connective tissue disease. Despite similarities in clinical and pathologic presentation, the prognosis and treatment of CTD associated ILD (CTD-ILD) can differ greatly from that of other forms of ILD, such as idiopathic pulmonary fibrosis. Pulmonary hypertension (PH) can present as a primary vasculopathy in pulmonary arterial hypertension or in association with ILD (PH-ILD). Therefore, detailed history, physical examination, targeted serologic testing, and, occasionally, lung biopsy are needed to diagnose CTD-ILD, whereas both non-invasive and invasive assessments of pulmonary hemodynamics are needed to diagnose pulmonary hypertension. Immunosuppression is the mainstay of treatment for ILD, although data from randomized controlled trials (RCTs) to support specific treatments are lacking. Furthermore, treatment strategies vary according to the clinical situation—for example, the treatment of a patient newly diagnosed as having CTD-ILD differs from that of someone with an acute exacerbation of the disease. Immunosuppression is indicated only in select cases of pulmonary arterial hypertension related to CTD; more commonly, selective pulmonary vasodilators are used. For both diseases, comorbidities such as sleep disordered breathing, symptoms of dyspnea, and cough should be evaluated and treated. Lung transplantation should be considered in patients with advanced disease but is not always feasible because of other manifestations of CTD and comorbidities. Clinical trials of novel therapies including immunosuppressive therapies are needed to inform best treatment strategies.  
feeds.bmj.com
over 4 years ago
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7

Emergency Medicine Literature of Note: No Single Reliable Criterion for Diagnosing Acute Heart Failure

I've always been an advocate for less radiation. I believe in reducing the excessive number of CTPAs for low-mod pretest probability VTE patients. Would I dare consider a CT for an undifferentiated dyspneic patient in whom I've actually ruled out PE?Not until recently. Because of my aversion to excessive testing, and hell, PE is off the table, what do you mean CT?But what I'm suggesting is to consider a SOB CT. For the sick patient, at risk for significant morbidity/mortality. Is it safe to continue admitting with a CXR, a diagnosis of multifactorial dyspnea, and a plan for fluids or diuretics or fluids? Or maybe antibiotics or nebs and steroids or anticoagulation?Excessive imaging risks radiation, high costs, and incidentalomas. But if your threshold for getting a SOB CT is as high as mine used to be, we're only considering it for the sick undifferentiated patient. CT is certainly not perfect, interstitial findings may not parse out pneumonia vs fluid overload, but most of the time your diagnostic uncertainty will be relieved. Ah, an evident pneumonia, maybe distinct consolidation, maybe patchy opacities, maybe findings consistent with heart failure, maybe malignancy, and sometimes even PE when you thought not. For the sick undifferentiated dyspneic patient stop futzing around and realize you have a pretty reliable simple test at your disposal.Try ultrasound first...  
emlitofnote.com
over 4 years ago
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Multi-Organ US Improves Diagnostic Accuracy in Acute Dyspnea

A new multi-organ ultrasound exam can be diagnostically useful in determining the root cause of acute dyspnea in the ED.  
medscape.com
over 4 years ago
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An often forgotten cause of chest pain

A 66 year old white woman presented to the emergency department of a district general hospital with shortness of breath and chest pain, which radiated to her back. She had previously received antibiotics from her general practitioner for a presumed chest infection. Comorbidities included drug controlled hypertension. On examination she was tachypnoeic and hypertensive with a blood pressure of 170/90 mm Hg. No disparity in blood pressure was seen between her arms. Because clinical signs and plain chest radiography were suggestive of a left sided basal pneumonia with associated parapneumonic effusion (fig 1⇓), she received intravenous antibiotics.  
feeds.bmj.com
over 4 years ago
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An often forgotten cause of chest pain

A 66 year old white woman presented to the emergency department of a district general hospital with shortness of breath and chest pain, which radiated to her back. She had previously received antibiotics from her general practitioner for a presumed chest infection. Comorbidities included drug controlled hypertension. On examination she was tachypnoeic and hypertensive with a blood pressure of 170/90 mm Hg. No disparity in blood pressure was seen between her arms. Because clinical signs and plain chest radiography were suggestive of a left sided basal pneumonia with associated parapneumonic effusion (fig 1⇓), she received intravenous antibiotics.  
feeds.bmj.com
over 4 years ago
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Lab Case 100 – Interpretation

A 56 year old female presents with 4 days of shortness of breath and chest pain. She is tachypnoeic and has a mild haemdynamic derangement.  
emergucate.com
over 4 years ago
24f7b2574452bd17a17fcf5df7cde627215d2d837810517299916954
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Shortness of Breath

Mind map revising causes of shortness of breath  
Mrs Malaika Smith
over 4 years ago
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A man with altered mental status and metabolic acidosis

A 52 year old man was brought to the emergency department for acute onset shortness of breath and confusion. On physical examination he was agitated and taking deep breaths at the rate of 28/min. Initial venous blood gas on ambient air showed pH 7.02, partial pressure of carbon dioxide 3.4 kPa, partial pressure of oxygen 4.1 kPa. …  
feeds.bmj.com
over 4 years ago
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A man with altered mental status and metabolic acidosis

A 52 year old man was brought to the emergency department for acute onset shortness of breath and confusion. On physical examination he was agitated and taking deep breaths at the rate of 28/min. Initial venous blood gas on ambient air showed pH 7.02, partial pressure of carbon dioxide 3.4 kPa, partial pressure of oxygen 4.1 kPa. …  
feeds.bmj.com
over 4 years ago
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Echo Case: Diagnose Dyspnea From the Doppler

Dr Wharton keeps something hidden from the patient's history. Can you make the diagnosis?  
medscape.com
about 4 years ago
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Imaging Case of the Week 207

The frontal chest x-ray is from a 23 year old with shortness of breath after inhaling a chemical. What radiological sign can be seen?With thanks to Dr. Basil Muharb for the image.  
emergucate.com
about 4 years ago
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Palliative Pharmacotherapy: State-of-the-Art Management

Managing symptoms of advanced cancer can greatly improve patient quality of life. This review describes the latest therapy for cachexia, anorexia, fatigue, delirium, and dyspnea.  
medscape.com
about 4 years ago