Cardiopulmonary Symptoms

Chapter 3: Cardiopulmonary Symptoms

Overview of Symptoms and Clinical Signs

  • Symptoms: Subjective clinical findings reported by patients during initial interviews.

  • Clinical Signs: Objective and measurable indicators such as vital signs and laboratory studies.

Cough

  • Definition: A protective reflex that can be voluntary or involuntary.

    • Effectiveness: Cough effectiveness can be diminished.

  • Classification:

    • Acute Cough:

    • Characteristics: Sudden onset, severe, short duration, self-limiting.

    • Chronic Cough:

    • Characteristics: Persistent, troublesome, lasting more than 3 weeks.

Cough Description

  • Types of Cough:

    • Effective Cough: Strong enough to clear airways.

    • Inadequate Cough: Too weak to mobilize secretions.

    • Productive Cough: Expulsion of mucus or other material.

    • Dry Cough: No moisture or secretions produced.

Sputum Production

  • Sputum: Substance expelled through coughing or throat clearing, includes secretions from airways, mouth, sinuses, and nose.

  • Phlegm: Secretions specifically from the lungs and tracheobronchial tree.

  • Normal Production Rate: Up to 100 mL/day.

  • Components of Sputum:

    • Mucus, cellular debris, microorganisms, blood, pus, foreign particles.

Characteristics of Sputum

  • Assessment Criteria:

    • Color

    • Consistency

    • Odor

    • Quantity

    • Time of Day

    • Presence of Blood: Indicates underlying issues.

Hemoptysis

  • Definition: Expectoration of sputum containing blood.

    • Causes and Assessment Parameters:

    • Amount:

      • Massive Hemoptysis: 400 mL to 600 mL in 24 hours.

      • Streaky Blood: Indicative of conditions like pulmonary infection or lung cancer.

    • Odor, Color, and Acuteness: Important for determining severity.

Hematemesis vs. Hemoptysis

  • Hematemesis: Vomited blood, source determination includes:

    • Oropharynx

    • Esophagus or stomach (often related to alcoholism or liver cirrhosis).

Dyspnea

  • Definition: The subjective experience of breathing discomfort, often leading to shortness of breath (SOB).

  • Cardinal Symptoms: Important in evaluating cardiac diseases.

  • Types of Dyspnea:

    • Cardiac/Circulatory:

    • Inadequate oxygen supply to tissues, primarily during exertion.

    • Psychogenic: Panic disorders, unrelated to exertion.

    • Hyperventilation: Breathing deeper and faster than needed by the body.

Classification of Dyspnea

  • Dyspnea can be acute, chronic, progressive, recurrent, paroxysmal (recurring), or episodic.

    • Chronic Dyspnea: Typically progressive.

Specific Types of Dyspnea

  • Paroxysmal Nocturnal Dyspnea (PND): Sudden dyspnea during sleep, linked to left heart failure and coughing.

  • Orthopnea: Difficulty breathing when lying down, also associated with left heart failure and fluid retention.

  • Trepopnea: Dyspnea when lying on one side, often due to pleural effusion.

  • Platypnea: Dyspnea in an upright position, reduced when lying down.

  • Orthodeoxia: Hypoxemia in an upright position that resolves when lying down, seen in right-to-left intracardiac shunts.

Causes of Dyspnea

  • Cardiac Ischemia: Decreased blood supply to the myocardium.

  • Inflammatory Disorders: Affecting thorax or abdomen.

  • Musculoskeletal Disorders: Trauma, anxiety, and referred pain.

  • Angina: Cardinal symptom of heart disease, warrants emergent assessment.

Chest Pain

  • Definition: Chest pain linked to respiratory conditions, often associated with how the chest wall or parietal pleura is involved.

  • Pleuritic Pain:

    • Characteristics: Sharp, inspiratory, sudden onset. Increases with inspiration, cough, or movement.

  • Chest Wall Pain: Often localized and related to musculature.

Dizziness and Syncope

  • Definition: Temporary loss of consciousness.

  • Common Causes:

    • Vasovagal Syncope: Most prevalent type.

    • Orthostatic Hypotension: Results in a significant drop (>20 torr) in systolic blood pressure upon standing.

Swelling (Edema)

  • Definition: Soft tissue swelling due to excess fluid.

  • Types of Edema:

    • Anasarca: Generalized edema throughout the body.

    • Ascites: Fluid accumulation in the abdominal cavity.

    • Bilateral Peripheral Edema: Commonly in ankles/lower legs, often due to right or left heart failure.

    • Cor Pulmonale: Right heart failure secondary to lung disease.

Fever, Chills, and Night Sweats

  • Normal Body Temperature: Ranges from 97°F to 99.5°F (36°C to 37.5°C).

  • Fever: Also called hyperthermia; often associated with infections.

  • Pulmonary Infections: Can cause specific fever patterns.

    • Conditions include lung abscess, empyema, tuberculosis, pneumonia.

    • Certain medications (corticosteroids) and immunocompromised states may result in absence of fever despite infections.

Headache and Altered Mental Status (AMS)

  • Headache: Often a result of cerebral hypoxia or hypercapnia (elevated CO2).

  • AMS in Hypercapnia: Ranges from minor alertness issues to coma. Assessment includes arterial blood gas (ABG) analysis.

  • Cognitive Changes: Memory issues, concentration difficulty, anxiety, irritability can occur with advanced pulmonary disorders.

Snoring and Daytime Somnolence

  • Snoring may be benign but becomes a concern if associated with sleep apnea, leading to sleep disturbances and excessive daytime sleepiness (somnolence).

  • Associated Risks: Can result in occupational and vehicular accidents, as well as social dysfunction.

Consequences of OSA

  • Patients with OSA might experience:

    • Excessive daytime sleepiness

    • Risk of accidents

    • Job loss

    • Social dysfunction

    • Severe potential effects include poor concentration, bedwetting, impotence, high blood pressure, along with other complications.

Gastroesophageal Reflux Disease (GERD)

  • Symptoms: Chronic heartburn and regurgitation.

  • Extraesophageal Manifestations:

    • Laryngitis, asthma, chronic dry cough, chest pain, dental erosion.

  • Risk Factors:

    • Obesity, cigarette smoking, pregnancy.

  • Relevance to Respiratory Therapists (RTs): Awareness of GERD is critical due to its impact on respiratory symptoms and management strategies associated with pulmonary conditions.