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Praxis Jan 2023Functional Heart Complaints Functional complaints often manifest as cardiac symptoms (palpitations, thoracic complaints, reduced performance, dyspnea). Prognostically...
Functional Heart Complaints Functional complaints often manifest as cardiac symptoms (palpitations, thoracic complaints, reduced performance, dyspnea). Prognostically relevant clinical situations must be identified or excluded through targeted diagnostics. In the absence of prognostically relevant diseases action is wanted only in the case of subjective suffering, which is significantly influenced by the patient's emotional processing of the experience. Various therapy options can be used to treat functional heart complaints (do nothing/ignore symptoms, optimal treatment of any underlying diseases, phytotherapy, antiarrhythmic drugs, interventional therapy, physical training, psychocardiological treatment, resilience strengthening etc.).
Topics: Humans; Heart; Arrhythmias, Cardiac; Emotions; Dyspnea; Anti-Arrhythmia Agents
PubMed: 36597684
DOI: 10.1024/1661-8157/a003953 -
Seminars in Oncology Nursing Feb 2022To provide oncology nurses with education on the specific distressing symptom of dyspnea in patients with advanced cancer, including proper assessment and a hierarchical... (Review)
Review
OBJECTIVE
To provide oncology nurses with education on the specific distressing symptom of dyspnea in patients with advanced cancer, including proper assessment and a hierarchical approach to both nonpharmacologic and pharmacologic dyspnea interventions.
DATA SOURCES
Sources include published research findings, literature reviews, and guidelines, as well as professional opinion from practicing nurses and clinicians.
CONCLUSION
Individuals with advanced cancer often experience the distressing respiratory symptom, dyspnea. Assessment tools and treatment recommendations and guidelines are available for clinicians to appropriately evaluate and treat dyspnea. Improved awareness of symptom presence and treatment options will assist nurses in advocating for their patients with advanced cancer and obtaining and delivering the necessary treatments for dyspnea relief.
IMPLICATIONS FOR NURSING
Published evidence supports the many treatment options available for dyspnea relief at varying levels. Assessment, individualized treatment, education, and reassessment are key and ongoing to assist patients with advanced cancer to achieve respiratory comfort.
Topics: Dyspnea; Humans; Neoplasms
PubMed: 35249771
DOI: 10.1016/j.soncn.2022.151255 -
Praxis Sep 2019CME: Nocturnal Dyspnea Nocturnal dyspnea has a broad range of differential diagnoses of sometimes serious and even life-threatening illnesses. Systematic assessment...
CME: Nocturnal Dyspnea Nocturnal dyspnea has a broad range of differential diagnoses of sometimes serious and even life-threatening illnesses. Systematic assessment starts with taking a detailed medical history to characterize the dyspnea and evaluate possible underlying diseases. The subsequent clinical and complementary evaluation should be targeted to detect possible diseases of the upper and lower respiratory tract, the lungs, disorders of control of breathing, heart diseases as well as neurological and, after exclusion of other causes, mental illnesses.
Topics: Diagnosis, Differential; Dyspnea; Heart Diseases; Humans
PubMed: 31480954
DOI: 10.1024/1661-8157/a003176 -
Respiration; International Review of... 2021Breathlessness, also known as dyspnoea, is a debilitating and frequent symptom. Several reports have highlighted the lack of dyspnoea in a subgroup of patients suffering... (Review)
Review
Breathlessness, also known as dyspnoea, is a debilitating and frequent symptom. Several reports have highlighted the lack of dyspnoea in a subgroup of patients suffering from COVID-19, sometimes referred to as "silent" or "happy hyp-oxaemia." Reports have also mentioned the absence of a clear relationship between the clinical severity of the disease and levels of breathlessness reported by patients. The cerebral complications of COVID-19 have been largely demonstrated with a high prevalence of an acute encephalopathy that could possibly affect the processing of afferent signals or top-down modulation of breathlessness signals. In this review, we aim to highlight the mechanisms involved in breathlessness and summarize the pathophysiology of COVID-19 and its known effects on the brain-lung interaction. We then offer hypotheses for the alteration of breathlessness perception in COVID-19 patients and suggest ways of further researching this phenomenon.
Topics: Brain; COVID-19; Dyspnea; Humans; SARS-CoV-2
PubMed: 34333497
DOI: 10.1159/000517400 -
Pediatric Pulmonology Dec 2021Although prolonged respiratory symptoms following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been described in adults, data are emerging...
INTRODUCTION
Although prolonged respiratory symptoms following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been described in adults, data are emerging that children also experience long-term sequelae of coronavirus disease 2019 (COVID-19). The respiratory sequelae of COVID-19 in children remain poorly characterized. In this study we describe health data and respiratory findings in pediatric patients presenting with persistent respiratory symptoms following COVID-19.
METHODS
This study included patients referred to Pulmonary Clinic at the Children's Hospital of Philadelphia between December 2020 and April 2021 (n = 29). Inclusion criteria included a history of SARS-CoV-2 RNA positivity or confirmed close household contact and suggestive symptoms. A retrospective chart review was performed and demographic, clinical, imaging, and functional test data were collected.
RESULTS
The mean age at presentation to clinic was 13.1 years (range: 4-19 years). Patients had persistent respiratory symptoms ranging from 1.3 to 6.7 months postacute infection. Persistent dyspnea and/or exertional dyspnea were present in nearly all (96.6%) patients at the time of clinic presentation. Other reported chronic symptoms included cough (51.7%) and exercise intolerance (48.3%). Fatigue was reported in 13.8% of subjects. Many subjects were overweight or obese (62.1%) and 11 subjects (37.9%) had a prior history of asthma. Spirometry and plethysmography were normal in most patients. The six-minute walk test (6MWT) revealed exercise intolerance and significant tachycardia in two-thirds of the nine children tested.
CONCLUSION
Exertional dyspnea, cough and exercise intolerance were the most common respiratory symptoms in children with postacute COVID-19 respiratory symptoms seen in an outpatient pulmonary clinic. Spirometry (and plethysmography when available), however, was mostly normal, and exertional intolerance was frequently demonstrated using the 6MWT.
Topics: Adult; COVID-19; Child; Dyspnea; Humans; RNA, Viral; Retrospective Studies; SARS-CoV-2
PubMed: 34534416
DOI: 10.1002/ppul.25671 -
Expert Review of Neurotherapeutics Jun 2020Dyspnea is a complex and debilitating non-motor symptom experienced by a significant proportion of PD patients which results in limitations to physical ability and a... (Review)
Review
INTRODUCTION
Dyspnea is a complex and debilitating non-motor symptom experienced by a significant proportion of PD patients which results in limitations to physical ability and a reduction in quality of life.
AREAS COVERED
The authors highlight the underlying pathophysiological mechanisms that can contribute to dyspnea in PD patients, and provide the clinician with a practical working algorithm for the management of such patients. The authors further highlight important clinical red flags that should be heeded in dyspneic PD patients and discuss therapeutic strategies for managing dyspnea.
EXPERT OPINION
Although awareness of dyspnea in PD is increasing, further studies of its prevalence and natural history at different stages of the disease are needed. In particular, it is important to determine whether dyspnea could be an early or prodromal disease manifestation. Although peripheral mechanisms are likely to play a major role in the pathophysiology of dyspnea, the possibility that central changes in brainstem ventilatory control may also play a part warrants further investigation.
Topics: Dyspnea; Humans; Parkinson Disease
PubMed: 32419523
DOI: 10.1080/14737175.2020.1763795 -
Annals of Emergency Medicine Feb 2024
Topics: Male; Humans; Dyspnea; Diagnosis, Differential
PubMed: 38245230
DOI: 10.1016/j.annemergmed.2023.08.480 -
Revista Brasileira de Ginecologia E... Nov 2021The puerperium is a complex period that begins with placental delivery and lasts for 6 weeks, during which readaptation of the female organism and redistribution of... (Review)
Review
The puerperium is a complex period that begins with placental delivery and lasts for 6 weeks, during which readaptation of the female organism and redistribution of blood volume occur. This period is conducive to the occurrence of thromboembolic events. In the context of the SARS-CoV-2 pandemic, the virus responsible for COVID-19, the attention of the scientific community and health professionals has been focused on obtaining insights on different aspects of this disease, including etiology, transmission, diagnosis, and treatment. Regarding the pregnancy-postpartum cycle, it is opportune to review the clinical conditions that can occur during this period and to investigate dyspnea as a postpartum symptom in order to avoid its immediate association with COVID-19 without further investigation, which can lead to overlooking the diagnosis of other important and occasionally fatal conditions.
Topics: COVID-19; Dyspnea; Female; Humans; Placenta; Postpartum Period; Pregnancy; SARS-CoV-2
PubMed: 34872145
DOI: 10.1055/s-0041-1736304 -
Heart & Lung : the Journal of Critical... 2023Besides dyspnoea and cough, patients with idiopathic pulmonary fibrosis (IPF) or sarcoidosis may experience distressing non-respiratory symptoms, such as fatigue or...
INTRODUCTION
Besides dyspnoea and cough, patients with idiopathic pulmonary fibrosis (IPF) or sarcoidosis may experience distressing non-respiratory symptoms, such as fatigue or muscle weakness. However, whether and to what extent symptom burden differs between patients with IPF or sarcoidosis and individuals without respiratory disease remains currently unknown.
OBJECTIVES
To study the respiratory and non-respiratory burden of multiple symptoms in patients with IPF or sarcoidosis and to compare the symptom burden with individuals without impaired spirometric values, FVC and FEV1 (controls).
METHODS
Demographics and symptoms were assessed in 59 patients with IPF, 60 patients with sarcoidosis and 118 controls (age ≥18 years). Patients with either condition were matched to controls by sex and age. Severity of 14 symptoms was assessed using a Visual Analogue Scale.
RESULTS
44 patients with IPF (77.3% male; age 70.6±5.5 years) and 44 matched controls, and 45 patients with sarcoidosis (48.9% male; age 58.1±8.6 year) and 45 matched controls were analyzed. Patients with IPF scored higher on 11 symptoms compared to controls (p<0.05), with the largest differences for dyspnoea, cough, fatigue, muscle weakness and insomnia. Patients with sarcoidosis scored higher on all 14 symptoms (p<0.05), with the largest differences for dyspnoea, fatigue, cough, muscle weakness, insomnia, pain, itch, thirst, micturition (night, day).
CONCLUSIONS
Generally, respiratory and non-respiratory symptom burden is significantly higher in patients with IPF or sarcoidosis compared to controls. This emphasizes the importance of awareness for respiratory and non-respiratory symptom burden in IPF or sarcoidosis and the need for additional research to study the underlying mechanisms and subsequent interventions.
Topics: Humans; Male; Adolescent; Aged; Middle Aged; Female; Cough; Sleep Initiation and Maintenance Disorders; Idiopathic Pulmonary Fibrosis; Sarcoidosis; Dyspnea; Fatigue; Muscle Weakness
PubMed: 37269615
DOI: 10.1016/j.hrtlng.2023.05.013 -
BMJ Supportive & Palliative Care Sep 2020Chronic breathlessness is a disabling and distressing condition for which there is a growing evidence base for a range of interventions. Non-pharmacological... (Review)
Review
Chronic breathlessness is a disabling and distressing condition for which there is a growing evidence base for a range of interventions. Non-pharmacological interventions are the mainstay of management and should be optimised prior to use of opioid medication. Opioids are being implemented variably in practice for chronic breathlessness. This narrative review summarises the evidence defining current opioids for breathlessness best practice and identifies remaining research gaps. There is level 1a evidence to support the use of opioids for breathlessness. The best evidence is for 10-30 mg daily de novo low-dose oral sustained-release morphine in opioid-naïve patients. This should be considered the current standard of care following independent, regulatory scrutiny by one of the world's therapeutics regulatory bodies. Optimal benefits are seen in steady state; however, there are few published data about longer term benefits or harms. Morphine-related adverse events are common but mostly mild and self-limiting on withdrawal of drug. Early and meticulous management of constipation, nausea and vomiting is needed particularly in the first week of administration. Serious adverse events are no more common than placebo in clinical studies. Observational studies in severe chronic lung disease do not show excess mortality or hospital admission in those taking opioids. We have no long-term data on immune or endocrine function. There are promising data regarding prophylaxis for exertion-related breathlessness, but given the risks associated with transmucosal fentanyl, caution is needed with regard to clinical use pending longer term, robust safety data.
Topics: Analgesics, Opioid; Chronic Disease; Dyspnea; Humans; Morphine; Treatment Outcome
PubMed: 32620683
DOI: 10.1136/bmjspcare-2020-002314