Scribd Logo
Upload

Welcome to Scribd!

  • 193 views

    Sherif EL Hawary, MD Professor of Internal Medicine Kasr AL Aini

    Uploaded by

    670411
    The document discusses various causes and presentations of common chest symptoms including cough, hemoptysis, chest pain, and dyspnea. It outlines different etiologies such as respiratory, cardiovascular, chest wall and other extra-thoracic causes. Key factors in evaluation are determining if symptoms are acute or chronic, productive vs dry cough, and presence of associated symptoms like wheezing. Major etiologies of each symptom are also highlighted.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd

    Sherif EL Hawary, MD Professor of Internal Medicine Kasr AL Aini

    Uploaded by

    670411
    193 views35 pages
    The document discusses various causes and presentations of common chest symptoms including cough, hemoptysis, chest pain, and dyspnea. It outlines different etiologies such as respiratory, cardiovascular, chest wall and other extra-thoracic causes. Key factors in evaluation are determining if symptoms are acute or chronic, productive vs dry cough, and presence of associated symptoms like wheezing. Major etiologies of each symptom are also highlighted.

    Original Title

    Chest Symptoms

    Copyright

    © Attribution Non-Commercial (BY-NC)

    Available Formats

    PPT, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    The document discusses various causes and presentations of common chest symptoms including cough, hemoptysis, chest pain, and dyspnea. It outlines different etiologies such as respiratory, cardiovascular, chest wall and other extra-thoracic causes. Key factors in evaluation are determining if symptoms are acute or chronic, productive vs dry cough, and presence of associated symptoms like wheezing. Major etiologies of each symptom are also highlighted.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    193 views35 pages

    Sherif EL Hawary, MD Professor of Internal Medicine Kasr AL Aini

    Uploaded by

    670411
    The document discusses various causes and presentations of common chest symptoms including cough, hemoptysis, chest pain, and dyspnea. It outlines different etiologies such as respiratory, cardiovascular, chest wall and other extra-thoracic causes. Key factors in evaluation are determining if symptoms are acute or chronic, productive vs dry cough, and presence of associated symptoms like wheezing. Major etiologies of each symptom are also highlighted.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 35

    Sherif EL Hawary, MD

    Professor of Internal Medicine


    Kasr AL Aini
    CHEST SYMPTOMS
    • COUGH
    • HEMOPTYSIS
    • CHEST PAIN
    • DYSPNEA
    COUGH
    ETIOLOGY

    Reflex Psychogenic Central


    (Hysterical) CVS
    1. Respiratory
    • Airway dis.: e.g. Bronchitis Encephalitis
    Brain tumours
    • Parenchymatous lung dis.: e.g. Lung abscess
    • Pleural dis.: e.g. Pleurisy

    2. Extra-respiratory
    • Cardiovascular dis.: e.g. Pulm congestion (LSHF)
    • Other causes: e.g. ACE – I
    APPROACH TO THE PATIENT
    1. Is the cough ACUTE or CHRONIC ??
    ACUTE (< 3 weeks): e.g. Pneumonia, Pulmonary embolism.
    CHRONIC (> 3 weeks): e.g. COPD, GORD.

    2. Is the cough DRY or PRODUCTIVE ??


    DRY: e.g. Pleurisy, Psychogenic, DRUG (ACE – I).
    PRODUCTIVE: e.g. Chronic bronchitis, Bronchiectasis, Lung abscess.

    3. Is there PERIODICITY ?? (DIURNAL or SEASONAL)


    DIURNAL
    (Early morning): e.g. Bronchitis, Br. asthma, Bronchiectasis.
    (Nocturnal): e.g. Cardiac asthma.
    SEASONAL (winter): e.g. Bronchitis, Br. asthma, Bronchiectasis.

    4. Is there associated WHEEZING ??


    GENERALISED: e.g. Bronchitis, Br. asthma, Bronchiectasis, COPD.
    LOCALISED: e.g. Br. carcinoma.

    5. Is the patient taking an ACE – I ??


    COMPLICATIONS

    Thoracic Extrathoracic
    1. Rupture pulm bleb
    2. Rupture bronchial varices
    3. Rupture aneurysm
    4. Stress fracture of a rib
    1. ↑ intra-abdominal pressure
    • Hernia
    • Prolapse
    • Stress incontinence
    2. ↑ intra-ocular pressure
    • Retinal & subconjunctival hemorrhage
    • Retinal detachement
    • Puffiness of eye lids

    3. ↑ intra-cranial pressure
    ● Rupture aneurysm SAH
    ● Cough syncope

    4. OTHERS
    ● Insomnia
    ● Cough-induced vomiting
    HEMOPTYSIS
    ETIOLOGY
    1) Respiratory causes:
    Laryngeal causes:
    Inflammation.
    Tumours.
    Tracheo-bronchial causes:
    Acute Bronchitis. (the most common cause)
    Bronchiectasis.
    Bronchial carcinoma.
    Bronchial adenoma.
    Pulmonary causes:
    Pulmonary TB.
    Pulmonary embolism.
    Pneumonia.
    Lung abscess.
    Goodpasture syndrome.

    2) Cardiovascular causes:
    Pulmonary congestion, e.g. MS & acute pulmonary oedema.
    Pulmonary infection.
    Pulmonary infraction.
    Rupture of bronchial varices.
    Rupture of aortic aneurysm.

    3) Systemic diseases:
    Hemorrhagic blood diseases, e.g.
    Hemophilia.
    Purpura.
    MANAGEMENT OF HEMOPTYSIS
    I. Diagnosis:
    1 Differentiation between hemoptysis & hematemesis:

    Hemoptysis Hematemesis
    Past history Chest disease GIT disease

    The attack Cough Vomiting


    Blood Bright red, frothy Dark red, food particles
    After the Streaked sputum Melena
    attack
    Examination Chest signs Abdominal signs

    Investigations Chest or heart disease GIT disease

    2 Exclusion of false hemoptysis:


    Examination of the upper resoiratory tract usually reveals the cause.

    3 Detection of the cause of hemoptysis:


    Clinical picture Investigations
    Treatment:
    1. Treatment of the cause.

    2. Cases of massive hemoptysis require:

    Hospitalization.
    Sedation.
    Blood transfusion & anti-shock measures.
    CHEST PAIN
    ETIOLOGY
    Cardiovascular causes:
    Myocardium: CAD (angina or infarction).
    Pericardium: Pericarditis or pericardial effusion.
    Endocardium: Mitral valve prolapse.
    Aorta Aortic aneurysm & Aortic dissection.
    Pulmonary: Pulmonary embolism & Pulmonary infarction.
    Pain of cardiac neurosis.
    Huge cardiomegaly.
    Respiratory causes:
    Pleural disease: pleurisy, pleural effusion, pneumothorax, hydropneumothorax.
    Pulmonary disease extending to the pleura , e.g. pneumonia & lung abscess.
    Acute massive lung collapse.

    Chest wall causes:


    Skin: wounds.
    Breast: mastitis, tumour.
    Ribs: osteomyelitis, tumour, fracture, Tietze syndrome.
    Intercostal muscles: myositis, muscle strain ( from severe cough).
    Intercostal nerves: nerve root pain ( herpes zoster).
    Mediastinal causes:
    Tumours, LN, Mediastinitis.

    GIT:
    GORD, peptic ulcer, cholecystitis.
    CAUSES OF ACUTE CHEST PAIN
    MYOCARDIUM: angina pectoris & acute myocardial infarction.
    PERICARDIUM: acute pericarditis.
    ENDOCARDIUM: mitral valve prolapse.
    AORTA: dissecting aneurysm of the aorta.
    PULMONARY: massive pulmonary embolism & pulmonary infarction.
    CARDIAC NEUROSIS.

    Pleural disease: acute pleurisy & pneumothorax.


    Lung disease: acute massive lung collapse.

    Musculo-skeletal disorders: Tietze syndrome.

    Nerve root pain: Herpetic neuralgia.

    GIT: GORD, peptic ulcer, cholecystitis.


    DYSPNEA
    ETIOLOGY
    Cardiovascular causes:
    Pulmonary congestion: Left – sided heart failure
    Pulmonary embolism .
    Pericardial effusion .
    Pathogenesis of cardiac dyspnea

    1) Pulm congestion → ↓ alveolar compliance due to interstitial oedema


    2) Low CO → fatigue & weakness of the respiratory muscles
    3) Pleural effusion → mechanical compression of the lungs
    4) Churchill Cope reflex
    5) Hypoxia → stimulates the respiratory centre
    Types of cardiac dyspnea

    1) Exertional
    2) Dyspnea at rest
    3) Orthopnea
    4) PND
    Chest causes:
    Laryngeal:
    - Foreign body, Tumours.

    Tracheo-bronchial:
    - Bronchitis, Br. asthma, Bronchiectasis, COPD.

    Lung:
    - Consolidation, Collapse.
    - Fibrosis (pulmonary, ILD).

    Pleural:
    - Pleurisy, pleural effusion, pneumothorax, hydropneumothorax.

    Chest wall:
    - Chest deformities, scleroderma, marked obesity (Pick syndrome).
    Abdominal causes:
    - Abdominal distension, e.g. marked ascites.

    General causes:
    - Anemia.
    - Hemorrhage & shock.
    - Acidosis.

    Psychogenic (Hysterical)
    Neurological causes:

    1- Diaphragmatic paralysis.

    2- Disorders of Neuro-muscular apparatus:


    CNS: Head injury, CVS, Drugs ( opiates & barbiturates).

    AHCs: MND, Poliomyelitis.


    Peripheral nerve: Polyneuropathy, e.g. GBS.
    NMJ: Myasthenia gravis.
    Muscle: Myopathies.
    CAUSES OF ACUTE DYSPNEA

    Acute massive myocardial infarction, (Acute LVF).


    Acute pulmonary embolism.
    Acute massive lung collapse.
    Pneumothorax (Tension).
    Pneumonia.
    Pleurisy.
    Bronchus: Bronchial asthma.
    Larynx: Inhaled FB, laryngeal spasm, laryngeal oedema.
    Hemorrhage, shock, acidosis.
    Hysterical.

    You might also like