Adult with exertional dyspnoea and abnormal ECG

Obesity is burning health issue for society nowadays. In Sutrasthana of Charaka Samhita, in different Adhyaya (eg. Astauninditiya, Langhanabrumhaniya, Santarpaniya) causes, symptoms and treatment of Sthaulya are described. As an alternative approach, Ayurvedic treatment may serve as promising modality. A 17 years old male patient came in P.D. Patel Ayurveda Hospital on 22th May 2017. Patients weight was 114.8 kg and BMI was 37.51 which fairly included in obesity category according to NHI guidelines. He also had some associated complaints like exertional dyspnoea, increased appetite, excessive perspiration. He was treated with Snehana (Aabhyantara and Bahya), Swedana, Vamana, Virechana, Niruha Basti, Udvartana along with oral medicines like Varunaadi Kwatha, Arogyavardhini Vati, Triphala Guggulu, and Navayasa Lauha along with prescribed dietary regimes and life style modification. He lost about 9.7 kg of weight, which was 105.1 kgs and BMI was 34.34 only in 26 days without any complications.

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Effects of sympathetic inhibition on exertional dyspnoea, ventilatory and metabolic responses to exercise in normotensive humans

Clinical Science ◽

10.1042/cs19990329 ◽

2000 ◽

Vol 99 (3) ◽

pp. 223 ◽

Cited By ~ 1

Author(s):

Stuart D.R. GALLOWAY ◽

Giuseppe DE VITO ◽

Sam McCLURE ◽

Myra A. NIMMO ◽

John J.V. McMURRAY

Keyword(s):

Metabolic Responses ◽

Exertional Dyspnoea

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Exertional dyspnoea in COPD: the clinical utility of cardiopulmonary exercise testing

European Respiratory Review ◽

10.1183/16000617.0054-2016 ◽

2016 ◽

Vol 25 (141) ◽

pp. 333-347 ◽

Cited By ~ 36

Author(s):

Denis E. O'Donnell ◽

Amany F. Elbehairy ◽

Azmy Faisal ◽

Katherine A. Webb ◽

J. Alberto Neder ◽

...

Keyword(s):

Physical Activity ◽

Exercise Testing ◽

Physiological Responses ◽

Cardiopulmonary Exercise Testing ◽

Chronic Obstructive ◽

Exertional Dyspnoea ◽

Obstructive Pulmonary Disease ◽

Respiratory Impairment ◽

Laboratory Exercise ◽

Cardiopulmonary Exercise

Activity-related dyspnoea is often the most distressing symptom experienced by patients with chronic obstructive pulmonary disease (COPD) and can persist despite comprehensive medical management. It is now clear that dyspnoea during physical activity occurs across the spectrum of disease severity, even in those with mild airway obstruction. Our understanding of the nature and source of dyspnoea is incomplete, but current aetiological concepts emphasise the importance of increased central neural drive to breathe in the setting of a reduced ability of the respiratory system to appropriately respond. Since dyspnoea is provoked or aggravated by physical activity, its concurrent measurement during standardised laboratory exercise testing is clearly important. Combining measurement of perceptual and physiological responses during exercise can provide valuable insights into symptom severity and its pathophysiological underpinnings. This review summarises the abnormal physiological responses to exercise in COPD, as these form the basis for modern constructs of the neurobiology of exertional dyspnoea. The main objectives are: 1) to examine the role of cardiopulmonary exercise testing (CPET) in uncovering the physiological mechanisms of exertional dyspnoea in patients with mild-to-moderate COPD; 2) to examine the escalating negative sensory consequences of progressive respiratory impairment with disease advancement; and 3) to build a physiological rationale for individualised treatment optimisation based on CPET.

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Exertional dyspnoea in a 28-year-old woman

Heart ◽

10.1136/heartjnl-2017-312174 ◽

2017 ◽

Vol 103 (22) ◽

pp. 1779-1829 ◽

Cited By ~ 1

Author(s):

Selma D Carlson ◽

Zachary L Steinberg ◽

Eric V Krieger

Keyword(s):

Exertional Dyspnoea

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Inspiratory Muscle Training Improves Lung Function and Reduces Exertional Dyspnoea in Mild/Moderateasthmatics

Clinical Science ◽

10.1042/cs095004pb ◽

1998 ◽

Vol 95 (s39) ◽

pp. 4P-4P ◽

Cited By ~ 11

Author(s):

AK McConnell ◽

MP Caine ◽

KJ Donovan ◽

AK Toogood ◽

MR Miller

Keyword(s):

Lung Function ◽

Inspiratory Muscle ◽

Inspiratory Muscle Training ◽

Exertional Dyspnoea ◽

Muscle Training

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Atrial myxoma: an unusual aetiology for exertional dyspnoea and palpitation

BMJ Case Reports ◽

10.1136/bcr-2017-223341 ◽

2017 ◽

pp. bcr-2017-223341

Author(s):

Omar Gutierrez ◽

Richard Michell ◽

Dale Adler

Keyword(s):

Atrial Myxoma ◽

Exertional Dyspnoea

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Uncovering the mechanisms of exertional dyspnoea in combined pulmonary fibrosis and emphysema

European Respiratory Journal ◽

10.1183/13993003.01319-2019 ◽

2019 ◽

Vol 55 (1) ◽

pp. 1901319 ◽

Cited By ~ 3

Author(s):

Camila M. Costa ◽

J. Alberto Neder ◽

Carlos G. Verrastro ◽

Marcelle Paula-Ribeiro ◽

Roberta Ramos ◽

...

Keyword(s):

Carbon Dioxide ◽

Pulmonary Fibrosis ◽

Exercise Capacity ◽

Minute Ventilation ◽

Volume Ratio ◽

Blood Gases ◽

Carbon Dioxide Tension ◽

Exertional Dyspnoea ◽

Ventilatory Efficiency ◽

Constant Work Rate

The prevailing view is that exertional dyspnoea in patients with combined idiopathic pulmonary fibrosis (IPF) and emphysema (CPFE) can be largely explained by severe hypoxaemia. However, there is little evidence to support these assumptions.We prospectively contrasted the sensory and physiological responses to exercise in 42 CPFE and 16 IPF patients matched by the severity of exertional hypoxaemia. Emphysema and pulmonary fibrosis were quantified using computed tomography. Inspiratory constraints were assessed in a constant work rate test: capillary blood gases were obtained in a subset of patients.CPFE patients had lower exercise capacity despite less extensive fibrosis compared to IPF (p=0.004 and 0.02, respectively). Exertional dyspnoea was the key limiting symptom in 24 CPFE patients who showed significantly lower transfer factor, arterial carbon dioxide tension and ventilatory efficiency (higher minute ventilation (V′E)/carbon dioxide output (V′CO2) ratio) compared to those with less dyspnoea. However, there were no between-group differences in the likelihood of pulmonary hypertension by echocardiography (p=0.44). High dead space/tidal volume ratio, low capillary carbon dioxide tension emphysema severity (including admixed emphysema) and traction bronchiectasis were related to a high V′E/V′CO2 ratio in the more dyspnoeic group. V′E/V′CO2 nadir >50 (OR 9.43, 95% CI 5.28–13.6; p=0.0001) and total emphysema extent >15% (2.25, 1.28–3.54; p=0.01) predicted a high dyspnoea burden associated with severely reduced exercise capacity in CPFEContrary to current understanding, hypoxaemia per se is not the main determinant of exertional dyspnoea in CPFE. Poor ventilatory efficiency due to increased “wasted” ventilation in emphysematous areas and hyperventilation holds a key mechanistic role that deserves therapeutic attention.

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‘When you hear hooves, think zebras, not horses’; two challenging cases of interstitial lung disease (ILD)

BMJ Case Reports ◽

10.1136/bcr-2018-224507 ◽

2019 ◽

Vol 12 (2) ◽

pp. bcr-2018-224507

Author(s):

Marissa O’Callaghan ◽

Aurelie Fabre ◽

Michael Keane ◽

Timothy J McDonnell

Keyword(s):

Interstitial Lung Disease ◽

Lung Disease ◽

Lung Fibrosis ◽

Lung Diseases ◽

Hypersensitivity Pneumonitis ◽

Usual Interstitial Pneumonia ◽

Case Series ◽

Imaging Features ◽

Exertional Dyspnoea ◽

Multidisciplinary Team Meeting

Our case series describes two siblings with complex fibrosing lung diseases. The first patient was initially given a diagnosis of sarcoidosis based on imaging and exclusion of alternative diagnoses. A number of years after diagnosis, he had rapid deterioration of his disease and following surgical lung biopsy, his lung fibrosis was re-classified as chronic hypersensitivity pneumonitis (cHP) with a usual interstitial pneumonia pattern. He subsequently underwent successful lung transplantation. The second patient presented with rapidly progressing exertional dyspnoea. His bloods, imaging, bronchoalveolar lavage and histology were discussed at our multidisciplinary team meeting. His histology was most in keeping with subacute on cHP with overlapping imaging features between the two siblings. He was treated accordingly but unfortunately succumbed to his illness shortly after diagnosis. These cases highlight the difficulties differentiating between the various interstitial lung disease (ILD) subtypes and the challenges in management while also increasing awareness of familial ILD.

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Salvage pulmonary thromboembolectomy for massive pulmonary embolism in a child presented with syncope and subsequent cardiac arrest

Cardiology in the Young ◽

10.1017/s1047951119001410 ◽

2019 ◽

Vol 29 (8) ◽

pp. 1094-1096

Author(s):

Koray Ak ◽

Yasar Birkan ◽

Figen Akalın ◽

Deniz Günay

Keyword(s):

Pulmonary Embolism ◽

Cardiac Arrest ◽

Cardiopulmonary Arrest ◽

Massive Pulmonary Embolism ◽

High Index ◽

Exertional Dyspnoea ◽

Pulmonary Embolectomy ◽

High Index Of Suspicion

AbstractPulmonary embolism is frequently under-recognised in children and, therefore, a high index of suspicion should be exerted on patients with exertional dyspnoea, presyncope/syncope and unexplained cardiopulmonary arrest. We discuss a 10-year-old previously healthy girl who presented with syncope and subsequent cardiac arrest related to massive pulmonary embolism and was salvaged successfully by emergent pulmonary embolectomy.

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