DYSPNEA

By:
Christian Syukur
Paulus Aditya B.

2013 - 061 114

2014 - 061 - 045

Advisor: dr. Febie Chriestya, Sp.PD, MSc.

KEPANITERAAN KLINIK DEPARTEMEN ILMU PENYAKIT DALAM
FAKULTAS KEDOKTERAN UNIVERSITAS KATOLIK INDONESIA
ATMA JAYA
Periode 21 September 2015 28 November 2015

Definisi
Pengalaman subyektif dari gangguan bernafas, yang
terdiri dari sensasi yang memiliki intensitas yang
bervariasi secara kualitatif (American Thoracic Society)

Mechanisms of Dyspnea
Respiratory centers
(Respiratory drive)

Chemoreceptors
Mechanoreceptor
s
Metaboreceptors

Sensory cortex
Feedback
Feed-forward
Error Signal

Dispnea intensity and

quality

Corollary
discharge
Motor Cortex
Ventilatory
muscles

Assessing Dyspnea (Quality of Sensation)

Descriptor

Clinical Examples

Pathophysiology

Chest tightness or
constriction

Asthma, CHF

Bronchoconstriction, interstitial edema

(asthma, myocardial ischemia)

Increased work or effort

of breathing

COPD, asthma,
neuromuscular disease,
chest wall restriction

Airway obstruction, neuromuscular disease

(COPD, moderate to severe asthma,
myopathy, kyphoscoliosis)

Air hunger, need to

CHF, COPD, asthma,
breathe, urge to breathe pulmonary embolism,
pulmonary fibrosis

Increased drive to breathe (CHF, pulmonary

embolism, moderate to severe airflow
obstruction)

Cannot get a deep

breath, unsatisfying
breath

Asthma, COPD, pulmonary

fibrosis, chest wall disease

Hyperinflation (asthma, COPD) and

restricted tidal volume (pulmonary fibrosis,
chest wall restriction)

Heavy breathing, rapid

breathing

Sedentary status in healthy

individual / patient with
cardiopulmonary disease

Deconditioning

Airways

Left Heart

Respiraoty
Disease
Chest Wall

Lung Parenchym

Dyspnea

Cardiovascular
Disease

Pulmonary Vasculature

Pericardium

Respiratory System Dyspnea

Disease of the Airways
Asthma
COPD

Disease of the Chest Wall

Kyphoscoliosis
Myasthenia Gravis
Guillain-Barre Syndrome

Disease of the Lung Parenchyma

Infections
Autoimmune Disorders

Cardiovascular System Dyspnea

Disease of the Left Heart
Coronary Artery Disease
Non-ischemic Cardomyopathies

Disease of the Pulmonary Vasculature

Pulmonary Hypertension
Pulmonary Thromboembolic Disease

Disease of the Pericardium

Constrictive Pericarditis
Cardiac Tamponade

Tatalaksana Dispneu

Edema Paru

Edema Paru Kardiogenik

Edema Paru Non-Kardiogenik

Bagaimana Membedakan edema paru

kardiogenik dan non-kardiogenik ?
Kardiogenik

Non-Kardiogenik

Riwayat

Penyakit jantung

kondisi tertentu

Pemeriksaan Fisik

S3 gallop, pe JVP, edema perifer

Rales dan/atau wheezing

Normal pada fase awal

Radiografi Thoraks

Perbesaran bayangan jantung

Redistribusi vaskular
Penebalan intersisial
Infiltrat alveolar perihiler
Efusi pleura sering

Ukuran jantung normal

Infiltrat alveolar di seluruh lapang
paru
Efusi pleura jarang

Penyebab hipoksemia

Mismatch ventilasi/perfusi

Shunting intrapulmoner

Respon suplementasi O2

(+)

(-)

THANK YOU!