Manifestations of respiratory system

dysfunctions

M. Tatar, J. Hanacek
Cardinal respiratory symptoms and signs

cough
sputum
dyspnea
wheezing
cyanosis
chest discomfort
chest pain
Disorders of lung mechanics
 Disorders of the lung mechanics
• Airway obstruction
– nasal cavity: nasal congestion
– pharynx: collapse during sleep
– larynx: suffocation
– central aw:
• trachea: stridor
• main bronchi: dyspnea, wheezing
• lobar bronchi: asymptomatic or minor dyspnea
– peripheral aw: dyspnea

• Lung parenchyma ( or compliance): dyspnea

• Chest wall (abnormalities): dyspnea
• Respiratory muscles (fatigue): dyspnea
Disorders of airway
defence mechanisms
Disorders of airways defence mechanisms

• Nasal cavity
– sneezing
– nasal dyscharge

• Airways
– Cough: acute respiratory infections, foreign body
aspiration, chronic bronchitis, chronic cough
– Expectoration - Sputum
• mucoid (mainly macrophages)
• purulent (neutrophils)
• Pneumococcus - bloody or rust-colored
• Pseudomonas, Haemophilus - green sputum
Hyperplasia and hypertrophy of submucosal glands
Disorders of gas
exchange
 Disorders of gas exchange

Respiratory insufficiency (failure)

– Hypoxemic
• Decreased ventilation/perfusion ratio
• Venous admixture
• Diffusion impairment
– Hypercapnic
• Overall alveolar hypoventilation
• Limits for hyperventilatory compensation
of decreased ventilation/perfusion ratio
Vznik hypoxémie vplyvom zníženia’V/Q pomeru
?
C
C

20 D
C

A
C
Vol % O2

B
C Vysoký V´A=1 /2
1

V´A/Q´
1
V´A= / 2 Nízky
V´A/Q´ Q´=1

10 Q´=1

Fyziologický V´A/Q´

V´A=1 V´A=1

Q´=1 Q´=1

20 40 60 80 100 120 mmHg

PaO2
Kompenzačné mechanizmy pri hyperkapnii
B

50
A
Vol % CO2
Nízky V´A=2/ 3
V´A/Q´
C Z

Q´ = 1
P
V´A=1 1/3
25
11/3 + 2/3 = 2
Vysoký Q´=1
V´A/Q´ Fyziologický V´A/Q´

Q´=1 V´A=1 V´A=1 Q´=1

mmHg 20 40
60
PaCO2
Disturbed regulation of breathing

Cheyne-Stokes respiration
Sleep apnea
Hyperventilation
Gasping
Hypopnea
Shortness of breath
Cheyne-Stokes breathing
 General body responses

Fever
Weakness, fatigue
Decreased exercise tolerance
Immunity: eosinophilia
Weight loss: advanced disease
 Cough

• Physiologic reflex

• Pathologic reflex

• Acute cough

• Chronic cough
– Rhinitis/sinusitis
– Asthma
– Gastroesophageal reflux disease
 Dyspnea

• Air hunger, chest tighness

• Subject´s feelings – needs for increased ventilatory activity

• Tachypnoea with either shallow or deep breathing

• Increased workload of respiratory muscles – normal gas

exchange cannot be achieved without increased ventilatory
effort
 Pathophysiology of dyspnea
• Hyperventilation – acute hypoxemia

• Relative hyperventilation - decreased ventilatory surfice

(atelectasis, pleural effusion, lung congestion,
pneumotorax)

• Disordered lung mechanics (most frequent cause)

- Upper airways stenosis
- Increased arways resistence = obstruction of peripheral
airways (asthma, COPD, heart failure)
- Decreased muscle force (polyomyelitis, diaphragm
paralysis, myastenia gravis)
- Limited chest movements (kyphoscoliosis)
- !!! acute or chronic state; rest or physical activity
 Causes of dyspnea

 oxygen content in atmosphere

 oxygen consumption during physical activity
Lung function disorders
Heart function disorders
Decreased hemoglobin content (during exercise)
Respiratory center dysfunction (Cheyne-Stokes, acidosis)
Stimulation of airway and lung nerve-endings (pneumonia, lung
congestion)
Obesity
Emotive factors (chronic hyperventilatory syndrom)
Brain dysorders
Metabolic dysorders – hyperthyreosis
 Hypoxemia

Tachycardia, tachypnea, dyspnea, mental status changes

Secondary polycythemia ( hematocrit)

Cyanosis
threshold for central cyanosis is a capillary reduced
hemoglobin content of 5 g/dL

!!! ancillary nonspecific signs

Relation between SaO2 and arterial Hb
 Cyanosis

• Central
– hemiglobin – methemoglobin, sulphhemoglobin
– hemoglobin -  content of reduced Hb
• Heart disorders – lung congestion
• Lung disorders
– acute: pneumonia, lung edema
– chronic: COPD, severe lung fibrosis

• Peripheral
– local perfusion disorders

• False
– pigmentation (silver)
 Peripheral and central cyanosis

Peripheral Central
 Hypercapnia

Morning headaches

Papilledema, dilated conjunctival and superficial facial

blood vessels

CO2 narcosis: anxiety may progress to delirium and

somnolency
 Primary respiratory disorders can significantly affect the
function of other systems

Most frequently CVS

Cor pulmonale
elevated jugular venous pulse, peripheral edema
Massive pulmonary embolism and tension pneumothorax
circulatory shock – hypotension, weakness, pale, sweaty,
oliguric, and develops impaired mentation
OSAS
daytime sleepiness, right heart failure, systemic arterial
hypertension