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Dyspnea

Dyspnea is commonly known as breathing difficulty or shortness of breath. It is noticed as difficulty in breathing or labored breathing. Tachypnea refers to rapid breathing. Progressively it can lead to hyperventilation such as experienced during an anxiety attack. Studies indicate that the origin of dyspnea is initiated with inaccurate central nervous system to the lungs with respect to breathing.


The etiology of dyspnea is related to conditions such as Pulmonary Embolism (PE), asthma, COPD, pulmonary ischemia and pneumonia. The management of dyspnea is only effective when the underlying causes are treated. In case of trauma, pneumothorax is an acute trigger for initiating the onset of dyspnea and hence emergency care is given to prevent internal bleeding that is caused in the pneumothorax. This condition can also progress into tachypnea and varied lung and heart sounds which has to be managed with effective ER procedures.


Positional dyspnea: If a person suffers dyspnea when lying down, it might be suggestive of CHF or pericardial effusion.

Exertional dyspnea: This occurs when there is reduction in oxygen supply and is mostly noticed in patients suffering cardiac disease or anemia.

Transient dyspnea: This situation usually resolves without medical intervention and is triggered by reversible causes such as panic attacks.

Recurrent dyspnea: Here the patient suffers these episodes many times.


Conditions such as pulmonary embolism can also lead to dyspnea along with tachycardia and diminished breathing patterns. Dyspnea is an immediate progressive condition usually associated with previous history of trauma or illness such as Tuberculosis, bronchopneumonia, infectious mononucleosis and sepsis in certain scenarios. Since dyspnea is an associated condition and it is predominantly an upper airway obstruction, the treatment measures are often related to avoiding exposure to chemicals, pollen, toxic fumes and gases such as carbon monoxide. Diagnostic tools such as Pulse Oximetry, blood tests for anemia, ECG and metabolic study are used to aid the diagnosis and then initiate appropriate treatment.


Neutrophilia

High levels of neutrophil in the blood results in neutrophilia; neutrophils are White Blood Cells or WBC that are assigned the task of killing/fighting off foreign matter like fungi and bacteria in the body. They are an important part of the body's defense force. An adequate amount of production and distribution of neutrophils is very important. However during an infection in the body, an elevated level of neutrophils can be found, with equal numbers in marginal and circulating pool.


The site of infection generates chemotactic agents and attracts neutrophils to the affected part. During recovery the flow of cells decreases from the marrow and this in turn decreases the amount of neutrophils. Neutrophilia is the most common form of leukocytosis - a condition wherein the blood has an increased number of leukocytes. When the cells shift from the marginal to circulating pool without an increase in the total blood granulocyte pool or if there is an increase in size of the TGBP, it could result in Neutrophilia.


Women in their childbearing age have a higher neutrophil count when compared to men. Pregnancy also leads to high neutrophil count and this may tend to increase during childbirth.


Neutrophilia occurrence

True Neutrophilia: True Neutrophilia occurs in most cases of infection and total blood granulocyte pool, the TGBP, may increase 5-6 times the normal level. At the onset of the infection, Neutrophilia count decreases and then it rises to very high levels.

Shift Neutrophilia: Shift Neutrophilia as the name indicates is transient (e.g. during heavy exercise) and may occur in association to other conditions. The change in numbers may last only for a few minutes. There is no change in the inflow of neutrophils from the bone marrow.


Causes for Neutrophilia

Neutrophilia is caused due to increase in bone marrow output or redistribution of white cells. Though there are numerous possibilities for an elevated level of neutrophils in the blood, the most common causes include:


  • Infections, caused by cocci, certain fungi, bacteria (local or generalized), viruses (chickenpox, herpes simplex) and parasites (hepatic amebiasis, Pneumocystis carinii) lead to Neutrophilia

  • Non-infectious inflammation like burns, post surgery, acute attack of gout, asthma, rheumatic fever, autoimmune conditions, any kind of trauma, tissue damage, myocardial infarction can also lead to Neutrophilia
  • Acute and sudden hemorrhage can lead to inflammation and thus lead to Neutrophilia.

  • Poisoning from sources like mercury, lead, digitalis, camphor, quinidine and certain insects can also lead to Neutrophilia

  • Metabolic changes in the body like diabetic ketoacidosis, uremia, etc can cause Neutrophilia

  • Malignancies and other kinds of spreading cancer, where the tumor outgrows the blood supply can lead to neutrophilia

  • Physiologic Neutrophilia is also caused by heavy exercise, epinephrine injections, etc

  • Other causes for Neutrophilia could include seizures, anemia, increase or decrease in platelet count, short or long term usage of corticosteroids, Cushing disease etc

  • Cigarette smoking can cause inflammation and thus lead to Neutrophilia.

  • High levels of stress can also lead to increase in levels of neutrophils and thus cause Neutrophilia.

  • Neutrophilia may be present without any particular cause that can be identified, this type of neutrophilia is called chronic idiopathic neutrophilia.

Diagnosis

Most often neutrophilia is a reactive phenomenon and can be diagnosed through blood tests. A physical examination is done and the medical history of the patient is studied. A complete blood count investigation and a series of blood tests are ordered for. In a few cases bone marrow aspiration is ordered for. The commons symptoms reported include decreased body temperature or hypothermia, dyspnea (labored breathing) or tachypnea (rapid breathing) and sometimes bleeding.



Pulmonary Infarction

Infarction means 'tissue death' in medical terminology. It is caused by obstruction of blood supply to the tissue leading to lack of oxygen. Infarct, which refers to the resulting lesion is derived from Latin, 'infarctus' which means 'stuffed into'. Pulmonary infarction refers to the death of a small area of lung resulting from pulmonary embolism. It occurs in a small, dead end pulmonary artery.


How does pulmonary infarction occur ?

Pulmonary infarction results from free floating thrombus, when many material substances including fat, tumor, septic emboli, air, and amniotic fluid and injected foreign material may form an emboli and move to the pulmonary circulation. In other words, plugging of a branch of the pulmonary artery by a clot (thrombosis) or by a piece of clot carried by the blood stream to the lung from a thrombus located elsewhere can result in pulmonary infarction. The involved area of the lung ceases to function and complication of the thrombosed veins leads to heart disease.


Causes of pulmonary infarction

The most common cause of pulmonary infarction is pulmonary embolism, but there are other conditions which can cause pulmonary infarction including cancer, and autoimmune diseases such as lupus. Sometimes, this condition may occur following a surgery. Other underlying conditions especially in children with pulmonary emboli include sickle cell disease, nephrotic syndrome, chemotherapy and Inherited hyper coagulable state and Vasculitis.


Symptoms of pulmonary infarction

Symptoms associated with pulmonary infarction include shortness of breath, chest pain, and blood sputum or hemoptysis. Sudden piercing pain in the chest which often radiates to the shoulder is noticed. Difficulty in breathing, irritating cough and blood tinged sputum are other signs. Persistent hiccups are present. Most often the patient is anxious with a rapid pulse, sweats profusely and has an elevated body temperature. In some severe cases, the patient may be in a state of shock.


Diagnosis of pulmonary infarction

Reflex broncho constriction is often associated with pulmonary embolism. Increased breathing and decreased pulmonary compliance with diminished surfactant levels may occur due to pulmonary infarction. This contributes to increased work of breathing and diminished oxygen levels. In sickle cell disease, there is sickling of RBCs within the small blood vessels of the lungs due to dehydration as a result of fever, Tachypnea (rapid breathing) and decreased intake, which can precipitate in a cycle of relative de oxygenation that further exacerbates the sickling tendency. Many also suffer a component of reactive airway disease and oxygenation is further decreased due to this factor.


Morbidity may include pulmonary hypertension, right ventricular failure and Cor Pulmonale, paradoxical embolization in patients with intracardiac defects, and sometimes side effects of medications used to treat pulmonary embolism. If pulmonary embolism is large, there could develop right ventricular strain and right heart failure as there is sudden increase in pulmonary artery pressure leading to right heart failure. A sudden pressure in the right ventricle can cause a leftward shift of the intraventricular septum, which may result in a classic obstructive shock, thereby impairing left ventricular filling.


Treating pulmonary infarction

It is timely treatment that is vital. If symptoms of pulmonary infection develop while at home, consult a physician at once. In case, shock develops, it is essential to get first aid treatment. Many times, patients are already in the hospital when pulmonary infarction occurs. Administration of oxygen, use of anticoagulants and prevention of infection are some other suggested line of treatment. Surgery may also be indicated.


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Collection of Pages - Last revised Date: September 24, 2019