Misplaced Pages

#110889

57-472: A RERA is characterized by increasing respiratory effort such as dyspneas (and thus decreasing esophageal pressures) for 10 seconds or more leading to an arousal from sleep, but one that does not fulfill the criteria for a hypopnea or apnea. The gold standard method for measuring RERAs is esophageal manometry , as recommended by the American Academy of Sleep Medicine (AASM). However, esophageal manometry

114-529: A microscope due to the components within their cells. Only skeletal and smooth muscles are part of the musculoskeletal system and only the muscles can move the body. Cardiac muscles are found in the heart and are used only to circulate blood ; like the smooth muscles, these muscles are not under conscious control. Skeletal muscles are attached to bones and arranged in opposing groups around joints . Muscles are innervated, whereby nervous signals are communicated by nerves , which conduct electrical currents from

171-497: A beneficial effect. Other important or common causes of shortness of breath include cardiac tamponade , anaphylaxis , interstitial lung disease , panic attacks , and pulmonary hypertension . It is more common among people with relatively small lungs. Around 2/3 of women experience shortness of breath as a part of a normal pregnancy . Cardiac tamponade presents with dyspnea, tachycardia, elevated jugular venous pressure, and pulsus paradoxus . The gold standard for diagnosis

228-576: A cause of dyspnea. Menstruation, particularly if excessive, can contribute to anaemia and to consequential dyspnea in women. Headaches are a symptom of dyspnea in patients with anaemia. Some patients report a numb sensation in their head, and others have reported blurred vision caused by hypotension behind the eye due to a lack of oxygen and pressure; these patients have reported severe head pains, which can lead to permanent brain damage. Symptoms can include loss of concentration, focus, fatigue, language faculty impairment, and memory loss. Shortness of breath

285-433: A chronic productive cough. An acute exacerbation presents with increased shortness of breath and sputum production. COPD is a risk factor for pneumonia ; thus this condition should be ruled out. In an acute exacerbation treatment is with a combination of anticholinergics , beta 2 -adrenoceptor agonists , steroids and possibly positive pressure ventilation . Asthma is the most common reason for presenting to

342-596: A fan may possibly be beneficial. Cognitive behavioural therapy may also be helpful. For people with severe, chronic, or uncontrollable breathlessness, non-pharmacological approaches to treating breathlessness may be combined with medication. For people who have cancer that is causing the breathlessness, medications that have been suggested include opioids, benzodiazepines, oxygen, and steroids. Results of recent systematic reviews and meta-analyses found opioids were not necessarily associated with more effectiveness in treatment for patients with advanced cancer. Ensuring that

399-804: A fever, dry cough, loss of smell and taste, and in moderate to severe cases, shortness of breath. Congestive heart failure frequently presents with shortness of breath with exertion, orthopnea , and paroxysmal nocturnal dyspnea . It affects between 1 and 2% of the general United States population and occurs in 10% of those over 65 years old. Risk factors for acute decompensation include high dietary salt intake, medication noncompliance, cardiac ischemia, abnormal heart rhythms , kidney failure , pulmonary emboli, hypertension , and infections. Treatment efforts are directed towards decreasing lung congestion. People with chronic obstructive pulmonary disease (COPD), most commonly emphysema or chronic bronchitis , frequently have chronic shortness of breath and

456-522: A large pulmonary embolism. A chest x-ray is useful to confirm or rule out a pneumothorax, pulmonary edema , or pneumonia . Spiral computed tomography with intravenous radiocontrast is the imaging study of choice to evaluate for pulmonary embolism. The primary treatment of shortness of breath is directed at its underlying cause. Extra supplemental oxygen is effective in those with hypoxia ; however, this has no effect in those with normal blood oxygen saturations . Individuals can benefit from

513-463: A pathophysiological basis the causes can be divided into: (1) an increased awareness of normal breathing such as during an anxiety attack, (2) an increase in the work of breathing and (3) an abnormality in the ventilatory or respiratory system. Ischemic strokes, hemorrhages, tumors, infections, seizures, and traumas at the brain stem can also cause shortness of breath, making them the only neurological causes of shortness of breath. The tempo of onset and

570-405: A pulmonary embolism in those who are at low risk, is not of much value if it is positive, as it may be positive in a number of conditions that lead to shortness of breath. A low level of brain natriuretic peptide is useful in ruling out congestive heart failure; however, a high level, while supportive of the diagnosis, could also be due to advanced age, kidney failure , acute coronary syndrome, or

627-454: A result of vocal cord dysfunction (VCD). Sarcoidosis is an inflammatory disease of unknown etiology that generally presents with dry cough, fatigue, and shortness of breath, although multiple organ systems may be affected, with involvement of sites such as the eyes, the skin and the joints. Different physiological pathways may lead to shortness of breath including via ASIC chemoreceptors , mechanoreceptors , and lung receptors . It

SECTION 10

#1732855208111

684-420: A role in the movement of bones. To allow motion, different bones are connected by joints. Cartilage prevents the bone ends from rubbing directly onto each other. Muscles contract to move the bone attached at the joint. There are, however, diseases and disorders that may adversely affect the function and overall effectiveness of the system. These diseases can be difficult to diagnose due to the close relation of

741-592: A variety of physical therapy interventions. Persons with neurological/neuromuscular abnormalities may have breathing difficulties due to weak or paralyzed intercostal, abdominal and/or other muscles needed for ventilation . Some physical therapy interventions for this population include active assisted cough techniques, volume augmentation such as breath stacking, education about body position and ventilation patterns and movement strategies to facilitate breathing. Pulmonary rehabilitation may alleviate symptoms in some people, such as those with COPD, but will not cure

798-405: Is / d ɪ s p ˈ n iː ə / disp- NEE -ə , with the p expressed and the stress on the /niː/ syllable. But pronunciations with a silent p in pn (as also in pneumo- ) are common ( / d ɪ s ˈ n iː ə / or / ˈ d ɪ s n i ə / ), as are those with the stress on the first syllable ( / ˈ d ɪ s p n i ə / or / ˈ d ɪ s n i ə / ). In English,

855-409: Is ultrasound . Anaphylaxis typically begins over a few minutes in a person with a previous history of the same. Other symptoms include urticaria , throat swelling , and gastrointestinal upset. The primary treatment is epinephrine . Interstitial lung disease presents with gradual onset of shortness of breath typically with a history of a predisposing environmental exposure. Shortness of breath

912-463: Is "shortness of breath". The American Thoracic Society defines dyspnea as: A subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity. Other definitions describe it as "difficulty in breathing", "disordered or inadequate breathing", "uncomfortable awareness of breathing", and as the experience of "breathlessness" (which may be either acute or chronic). While shortness of breath

969-412: Is a complex structure with two distinct divisions; the axial skeleton , which includes the vertebral column , and the appendicular skeleton . The skeletal system serves as a framework for tissues and organs to attach themselves to. This system acts as a protective structure for vital organs. Major examples of this are the brain being protected by the skull and the lungs being protected by

1026-438: Is a joint that allows some movement, and false joints or synarthroses , joints that are immovable, that allow little or no movement and are predominantly fibrous . Synovial joints , joints that are not directly joined, are lubricated by a solution called synovial fluid that is produced by the synovial membranes . This fluid lowers the friction between the articular surfaces and is kept within an articular capsule , binding

1083-570: Is a lack of evidence to recommend midazolam , nebulised opioids, the use of gas mixtures, or cognitive-behavioral therapy yet. Non-pharmacological interventions provide key tools for the management of breathlessness. Potentially beneficial approaches include active management of psychosocial issues ( anxiety , depression , etc.), and implementation of self-management strategies, such as physical and mental relaxation techniques , pacing techniques, energy conservation techniques, learning exercises to control breathing, and education . The use of

1140-406: Is a small fluid-filled sac made of white fibrous tissue and lined with synovial membrane . Bursa may also be formed by a synovial membrane that extends outside of the joint capsule . It provides a cushion between bones and tendons or muscles around a joint; bursa are filled with synovial fluid and are found around almost every major joint of the body. Because many other body systems, including

1197-626: Is common in people with cancer and may be caused by numerous different factors. In people with advanced cancer, periods of time with severe shortness of breath may occur, along with a more continuous feeling of breathlessness. Treatments include both nonpharmacological and pharmacological interventions. Nonpharmacological interventions that showed improvement in breathlessness include fans, behavioral and pyschoeducational approaches, exercise and pulmonary rehabilitation. Integrative medicine options include acupuncture/acupressure/reflexology, meditation and music therapy, with acupuncture/reflexology found to have

SECTION 20

#1732855208111

1254-424: Is due to asthma , pneumonia , cardiac ischemia , COVID-19 , interstitial lung disease , congestive heart failure , chronic obstructive pulmonary disease , or psychogenic causes, such as panic disorder and anxiety (see Psychogenic disease and Psychogenic pain ) . The best treatment to relieve or even remove shortness of breath typically depends on the underlying cause. Dyspnea, in medical terms,

1311-574: Is generally caused by disorders of the cardiac or respiratory system , others such as the neurological , musculoskeletal , endocrine , hematologic , and psychiatric systems may be the cause. DiagnosisPro, an online medical expert system , listed 497 distinct causes in October 2010. The most common cardiovascular causes are myocardial infarction and heart failure while common pulmonary causes include chronic obstructive pulmonary disease , asthma , pneumothorax , pulmonary edema and pneumonia . On

1368-479: Is often the only symptom in those with tachydysrhythmias . Panic attacks typically present with hyperventilation , sweating, and numbness . They are however a diagnosis of exclusion . Neurological conditions such as spinal cord injury, phrenic nerve injuries, Guillain–Barré syndrome , amyotrophic lateral sclerosis , multiple sclerosis and muscular dystrophy can all cause an individual to experience shortness of breath. Shortness of breath can also occur as

1425-399: Is often used to assess the clinical probability. Treatment, depending on severity of symptoms, typically starts with anticoagulants ; the presence of ominous signs (low blood pressure) may warrant the use of thrombolytic drugs . Anemia that develops gradually usually presents with exertional dyspnea, fatigue, weakness, and tachycardia . It may lead to heart failure . Anaemia is often

1482-932: Is the primary reason 3.5% of people present to the emergency department in the United States. Of these individuals, approximately 51% are admitted to the hospital and 13% are dead within a year. Some studies have suggested that up to 27% of hospitalized people develop dyspnea, while in dying patients 75% will experience it. Acute shortness of breath is the most common reason people requiring palliative care visit an emergency department. Up to 70% of adults with advanced cancer also experience dyspnoea. English dyspnea comes from Latin dyspnoea , from Greek dyspnoia , from dyspnoos , which literally means "disordered breathing". Its combining forms ( dys- + -pnea ) are familiar from other medical words, such as dysfunction ( dys- + function ) and apnea ( a- + -pnea ). The most common pronunciation in medical English

1539-473: Is thought that three main components contribute to dyspnea: afferent signals, efferent signals, and central information processing. It is believed the central processing in the brain compares the afferent and efferent signals; and dyspnea results when a "mismatch" occurs between the two: such as when the need for ventilation (afferent signaling) is not being met by physical breathing (efferent signaling). Afferent signals are sensory neuronal signals that ascend to

1596-533: Is uncomfortable for patients, may disrupt sleep and is impractical to use in most sleep centers . Some research studies have found that a high RDI was significantly correlated with excessive daytime sleepiness , and that this correlation was stronger than that for the frequency of oxygen saturation decreases below 85%, but other studies have found only a weak and unreliable correlation. More recent studies have found more impressive outcomes of methods in treating patients with RERAs and respiratory events that satisfy

1653-412: The central nervous system and cause the muscles to contract. In mammals , when a muscle contracts, a series of reactions occur. Muscle contraction is stimulated by the motor neuron sending a message to the muscles from the somatic nervous system . Depolarization of the motor neuron results in neurotransmitters being released from the nerve terminal . The space between the nerve terminal and

1710-551: The human locomotor system , and previously the activity system ) is an organ system that gives humans the ability to move using their muscular and skeletal systems . The musculoskeletal system provides form, support, stability, and movement to the body. The human musculoskeletal system is made up of the bones of the skeleton , muscles , cartilage , tendons , ligaments , joints , and other connective tissue that supports and binds tissues and organs together. The musculoskeletal system's primary functions include supporting

1767-410: The liver . Here all erythrocytes , platelets , and most leukocytes form in adults. From the red marrow, erythrocytes, platelets, and leukocytes migrate to the blood to do their special tasks. Another function of bones is the storage of certain minerals. Calcium and phosphorus are among the main minerals being stored. The importance of this storage "device" helps to regulate mineral balance in

Respiratory disturbance index - Misplaced Pages Continue

1824-421: The respiratory muscles . The most important respiratory muscle is the diaphragm . Other respiratory muscles include the external and internal intercostal muscles , the abdominal muscles and the accessory breathing muscles. As the brain receives its plentiful supply of afferent information relating to ventilation, it is able to compare it to the current level of respiration as determined by the efferent signals. If

1881-454: The rib cage . Located in long bones are two distinctions of bone marrow (yellow and red). The yellow marrow has fatty connective tissue and is found in the marrow cavity . During starvation, the body uses the fat in yellow marrow for energy. The red marrow of some bones is an important site for blood cell production, approximately 2.6 million red blood cells per second in order to replace existing cells that have been destroyed by

1938-419: The vascular , nervous , and integumentary systems , are interrelated, disorders of one of these systems may also affect the musculoskeletal system and complicate the diagnosis of the disorder's origin. Diseases of the musculoskeletal system mostly encompass functional disorders or motion discrepancies; the level of impairment depends specifically on the problem and its severity. In a study of hospitalizations in

1995-884: The United States, the most common inpatient OR procedures in 2012 involved the musculoskeletal system: knee arthroplasty, laminectomy, hip replacement, and spinal fusion. Articular (of or pertaining to the joints) disorders are the most common. However, also among the diagnoses are: primary muscular diseases, neurologic (related to the medical science that deals with the nervous system and disorders affecting it) deficits, toxins, endocrine abnormalities, metabolic disorders, infectious diseases, blood and vascular disorders, and nutritional imbalances. Disorders of muscles from another body system can bring about irregularities such as: impairment of ocular motion and control, respiratory dysfunction, and bladder malfunction. Complete paralysis , paresis , or ataxia may be caused by primary muscular dysfunctions of infectious or toxic origin; however,

2052-647: The average number of episodes of obstructive apnea, hypopnea, and respiratory event-related arousal per hour of sleep. (TST is "total sleep time".) Shortness of breath Shortness of breath ( SOB ), known as dyspnea (in AmE ) or dyspnoea (in BrE ), is an uncomfortable feeling of not being able to breathe well enough. The American Thoracic Society defines it as "a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity", and recommends evaluating dyspnea by assessing

2109-414: The balance between side effects and adverse effects from medications and potential improvements from medications needs to be carefully considered before prescribing medication. The use of systematic corticosteriods in palliative care for people with cancer is common, however the effectiveness and potential adverse effects of this approach in adults with cancer has not been well studied. Shortness of breath

2166-432: The bloodstream. When the fluctuation of minerals is high, these minerals are stored in the bone ; when it is low they will be withdrawn from the bone. There are three types of muscles— cardiac , skeletal , and smooth . Smooth muscles are used to control the flow of substances within the lumens of hollow organs , and are not consciously controlled . Skeletal and cardiac muscles have striations that are visible under

2223-438: The body, allowing motion, and protecting vital organs. The skeletal portion of the system serves as the main storage system for calcium and phosphorus and contains critical components of the hematopoietic system . This system describes how bones are connected to other bones and muscle fibers via connective tissue such as tendons and ligaments. The bones provide stability to the body. Muscles keep bones in place and also play

2280-450: The brain. Afferent neurons significant in dyspnea arise from a large number of sources including the carotid bodies , medulla , lungs , and chest wall . Chemoreceptors in the carotid bodies and medulla supply information regarding the blood gas levels of O 2 , CO 2 and H . In the lungs, juxtacapillary (J) receptors are sensitive to pulmonary interstitial edema, while stretch receptors signal bronchoconstriction. Muscle spindles in

2337-461: The breath. It however may atypically present with shortness of breath alone. Risk factors include old age, smoking , hypertension , hyperlipidemia , and diabetes . An electrocardiogram and cardiac enzymes are important both for diagnosis and directing treatment. Treatment involves measures to decrease the oxygen requirement of the heart and efforts to increase blood flow. People that have been infected by COVID-19 may have symptoms such as

Respiratory disturbance index - Misplaced Pages Continue

2394-434: The chest wall signal the stretch and tension of the respiratory muscles. Thus, poor ventilation leading to hypercapnia , left heart failure leading to interstitial edema (impairing gas exchange), asthma causing bronchoconstriction (limiting airflow) and muscle fatigue leading to ineffective respiratory muscle action could all contribute to a feeling of dyspnea. Efferent signals are the motor neuronal signals descending to

2451-865: The chest, jugular venous distension , and tracheal deviation. The symptoms of pneumonia are fever , productive cough , shortness of breath, and pleuritic chest pain . Inspiratory crackles may be heard on exam. A chest x-ray can be useful to differentiate pneumonia from congestive heart failure . As the cause is usually a bacterial infection, antibiotics are typically used for treatment. Pulmonary embolism classically presents with an acute onset of shortness of breath. Other presenting symptoms include pleuritic chest pain , cough, hemoptysis , and fever . Risk factors include deep vein thrombosis , recent surgery, cancer , and previous thromboembolism . It must always be considered in those with acute onset of shortness of breath owing to its high risk of mortality. Diagnosis, however, may be difficult and Wells Score

2508-534: The definition of hypopneas in all aspects other than reduction of oxygen saturation levels. The American Academy of Sleep Medicine uses RDI to determine the severity of Obstructive Sleep Apnea according to the following range: 5–14.9 for mild, 15–29.9 for moderate, and 30+ for severe, similar to the one used in the AHI. The formula to assessing the RDI is = (RERAs + Hypopneas + Apneas) X 60 / TST (in minutes). That is, RDI means

2565-405: The degree of shortness of breath. It may be subjectively rated on a scale from 1 to 10 with descriptors associated with the number (The Modified Borg Scale ). The MRC breathlessness scale suggests five grades of dyspnea based on the circumstances and severity in which it arises. A number of labs may be helpful in determining the cause of shortness of breath. D-dimer , while useful to rule out

2622-628: The distal and proximal ends, and the tendon binds to the periosteum of individual bones at the muscle's origin and insertion. As muscles contract, tendons transmit the forces to the relatively rigid bones, pulling on them and causing movement. Tendons can stretch substantially, allowing them to function as springs during locomotion, thereby saving energy. The Joints are structures that connect individual bones and may allow bones to move against each other to cause movement. There are three divisions of joints, diarthroses which allow extensive mobility between two or more articular heads; amphiarthrosis , which

2679-804: The duration of dyspnea are useful in knowing the etiology of dyspnea. Acute shortness of breath is usually connected with sudden physiological changes, such as laryngeal edema , bronchospasm , myocardial infarction , pulmonary embolism , or pneumothorax . Patients with COPD and idiopathic pulmonary fibrosis (IPF) have a mild onset and gradual progression of dyspnea on exertion, punctuated by acute exacerbations of shortness of breath. In contrast, most asthmatics do not have daily symptoms, but have intermittent episodes of dyspnea, cough, and chest tightness that are usually associated with specific triggers, such as an upper respiratory tract infection or exposure to allergens. Acute coronary syndrome frequently presents with retrosternal chest discomfort and difficulty catching

2736-624: The emergency room with shortness of breath. It is the most common lung disease in both developing and developed countries affecting about 5% of the population. Other symptoms include wheezing , tightness in the chest, and a non productive cough. Inhaled corticosteroids are the preferred treatment for children, however these drugs can reduce the growth rate. Acute symptoms are treated with short-acting bronchodilators. Pneumothorax presents typically with pleuritic chest pain of acute onset and shortness of breath not improved with oxygen. Physical findings may include absent breath sounds on one side of

2793-531: The intensity of its distinct sensations, the degree of distress and discomfort involved, and its burden or impact on the patient's activities of daily living . Distinct sensations include effort/work to breathe, chest tightness or pain, and "air hunger" (the feeling of not enough oxygen). The tripod position is often assumed to be a sign. Dyspnea is a normal symptom of heavy physical exertion but becomes pathological if it occurs in unexpected situations, when resting or during light exertion. In 85% of cases it

2850-643: The joint with its taut tissue. A ligament is a small band of dense, white, fibrous elastic tissue . Ligaments connect the ends of bones together in order to form a joint. Most ligaments limit dislocation , or prevent certain movements that may cause breaks. Since they are only elastic they increasingly lengthen when under pressure. When this occurs the ligament may be susceptible to break resulting in an unstable joint. Ligaments may also restrict some actions: movements such as hyper extension and hyper flexion are restricted by ligaments to an extent. Also ligaments prevent certain directional movement. A bursa

2907-802: The level of respiration is inappropriate for the body's status then dyspnea might occur. There is also a psychological component to dyspnea, as some people may become aware of their breathing in such circumstances but not experience the typical distress of dyspnea. The initial approach to evaluation begins by assessment of the airway, breathing, and circulation followed by a medical history and physical examination . Signs and symptoms that represent significant severity include hypotension , hypoxemia , tracheal deviation , altered mental status, unstable dysrhythmia , stridor , intercostal indrawing, cyanosis , tripod positioning , pronounced use of accessory muscles ( sternocleidomastoid , scalenes ) and absent breath sounds. A number of scales may be used to quantify

SECTION 50

#1732855208111

2964-449: The method used to derive the count. While some consider certain structures to be a single bone with multiple parts, others may see it as a single part with multiple bones. There are five general classifications of bones. These are long bones , short bones , flat bones , irregular bones , and sesamoid bones . The human skeleton is composed of both fused and individual bones supported by ligaments , tendons , muscles and cartilage . It

3021-538: The muscle cell is called the neuromuscular junction . These neurotransmitters diffuse across the synapse and bind to specific receptor sites on the cell membrane of the muscle fiber . When enough receptors are stimulated, an action potential is generated and the permeability of the sarcolemma is altered. This process is known as initiation. A tendon is a tough, flexible band of fibrous connective tissue that connects muscles to bones. The extra-cellular connective tissue between muscle fibers binds to tendons at

3078-481: The musculoskeletal system to other internal systems. The musculoskeletal system refers to the system having its muscles attached to an internal skeletal system and is necessary for humans to move to a more favorable position. Complex issues and injuries involving the musculoskeletal system are usually handled by a physiatrist (specialist in physical medicine and rehabilitation ) or an orthopaedic surgeon . The skeletal system serves many important functions; it provides

3135-411: The shape and form for the body, support and protection, allows bodily movement, produces blood for the body, and stores minerals. The number of bones in the human skeletal system is a controversial topic. Humans are born with over 300 bones; however, many bones fuse together between birth and maturity. As a result, an average adult skeleton consists of 206 bones. The number of bones varies according to

3192-528: The underlying disease. Fan therapy to the face has been shown to relieve shortness of breath in patients with a variety of advanced illnesses including cancer. The mechanism of action is thought to be stimulation of the trigeminal nerve. Systemic immediate release opioids are beneficial in emergently reducing the symptom severity of shortness of breath due to both cancer and non cancer causes; long-acting/sustained-release opioids are also used to prevent/continue treatment of dyspnea in palliative setting. There

3249-518: The various -pnea - suffixed words commonly used in medicine do not follow one clear pattern as to whether the /niː/ syllable or the one preceding it is stressed; the p is usually expressed but is sometimes silent depending on the word. The following collation or list shows the preponderance of how major dictionaries pronounce and transcribe them (less-used variants are omitted): Shortness Of Breath (Dyspnea) StatPearls Musculoskeletal The human musculoskeletal system (also known as

#110889