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목차
DYSPNEA
PULMONARY EDEMA
REFERENCES
PULMONARY EDEMA
REFERENCES
본문내용
좌심실 순응도 감소가 또한 발생될 것이고, 이러한 두가지 요인들이 혈역동학적으로 폐부종을 유발하기에 충분한 좌심방압 상승에 기여할 것이다. 일부 실험적 증거는 교감신경 수용체의 자극이 직접적으로 모세혈관 투과성을 증가시킨다는 것을 시사하나, 이러한 효과는 Starling forces의 불균형에 비하여 상대적으로 경미하다.
TREATMENT OF PULMONARY EDEMA See Chap. 195.
REFERENCES
COLICE GL: Detecting the presence and cause of pulmonary edema. Postgrad Med 93:161, 169, 1993
CRAPO JD: New concepts in the formation of pulmonary edema. Am Rev Respir Dis 147:790, 1993
DEPASO WJ et al: Chronic dyspnea unexplained by history, physical examination, chest roentgenogram and spirometry. Chest 100:1293, 1991
ELLIOTT MW et al: The language of breathlessness: Use of verbal descriptors by patients with cardiopulmonary diseases. Am Rev Respir Dis 144:826, 1991
INGRAM RH JR, BRAUNWALD E: Pulmonary edema: Cardiogenic and noncardiogenic, in Heart Disease, 4th ed, E Braunwald (ed). Philadelphia, Saunders, 1992, p 551
MAHLER DA et al: Measurement of breathlessness during exercise in asthmatics. Am Rev Respir Dis 144:39, 1991
SCHWARTZSTEIN RM et al: Dyspnea: A sensory experience. Lung 169:543, 1991
WASSERMAN K, CASABURI R: Dyspnea: Physiological and pathophysiological mechanisms. Annu Rev Med 39:503, 1988
Title: Chronic dyspnea unexplained by history, physical examination, chest roentgenogram, and spirometry. Analysis of a seven-year experience
Journal: Chest 100:1293-1299, 1991
Publication Date: 1991 Nov
Author(s): DePaso WJ, Winterbauer RH, Lusk JA, Dreis DF, Springmeyer SC
Abstract: The purpose of this article is to describe the spectrum and frequency of diseases presenting as unexplained dyspnea and to develop a logical diagnostic approach to such patients. Seventy-two consecutive physician-referred patients had dyspnea greater than one-month duration unexplained by the initial history, physical examination, chest roentgenogram, and spirometry. Patients underwent a standard diagnostic evaluation. A definite cause for dyspnea was recognized in 58 patients, and no answer was found in 14. Twenty-two diseases were recognized in the patient group. Dyspnea was due to pulmonary disease in 26 (36 percent) patients, cardiac disease in ten (14 percent) patients, hyperventilation in 14 (19 percent) patients, and only 3 patients had extrathoracic disease causing dyspnea. Age younger than 40 years, intermittent dyspnea, and normal alveolar-arterial oxygen pressure difference (P(A-a)O2) at rest breathing room air was strongly predictive of bronchial hyperreactivity or hyperventilation. No patient diagnosed as having disease of the lung parenchyma or vasculature had a P(A-a)O2 less than or equal to 20 mm Hg. The differential diagnosis to explain dyspnea in patients with nondirective histories, normal findings from physical examinations, normal chest roentgenograms, and normal spirograms is extensive. The patient's age and measurement of gas exchange at rest help to formulate a diagnostic approach.
Address: Section of Pulmonary and Critical Care Medicine, Virginia Mason Medical Center, Seattle, Washington.
UI: 92036622
TREATMENT OF PULMONARY EDEMA See Chap. 195.
REFERENCES
COLICE GL: Detecting the presence and cause of pulmonary edema. Postgrad Med 93:161, 169, 1993
CRAPO JD: New concepts in the formation of pulmonary edema. Am Rev Respir Dis 147:790, 1993
DEPASO WJ et al: Chronic dyspnea unexplained by history, physical examination, chest roentgenogram and spirometry. Chest 100:1293, 1991
ELLIOTT MW et al: The language of breathlessness: Use of verbal descriptors by patients with cardiopulmonary diseases. Am Rev Respir Dis 144:826, 1991
INGRAM RH JR, BRAUNWALD E: Pulmonary edema: Cardiogenic and noncardiogenic, in Heart Disease, 4th ed, E Braunwald (ed). Philadelphia, Saunders, 1992, p 551
MAHLER DA et al: Measurement of breathlessness during exercise in asthmatics. Am Rev Respir Dis 144:39, 1991
SCHWARTZSTEIN RM et al: Dyspnea: A sensory experience. Lung 169:543, 1991
WASSERMAN K, CASABURI R: Dyspnea: Physiological and pathophysiological mechanisms. Annu Rev Med 39:503, 1988
Title: Chronic dyspnea unexplained by history, physical examination, chest roentgenogram, and spirometry. Analysis of a seven-year experience
Journal: Chest 100:1293-1299, 1991
Publication Date: 1991 Nov
Author(s): DePaso WJ, Winterbauer RH, Lusk JA, Dreis DF, Springmeyer SC
Abstract: The purpose of this article is to describe the spectrum and frequency of diseases presenting as unexplained dyspnea and to develop a logical diagnostic approach to such patients. Seventy-two consecutive physician-referred patients had dyspnea greater than one-month duration unexplained by the initial history, physical examination, chest roentgenogram, and spirometry. Patients underwent a standard diagnostic evaluation. A definite cause for dyspnea was recognized in 58 patients, and no answer was found in 14. Twenty-two diseases were recognized in the patient group. Dyspnea was due to pulmonary disease in 26 (36 percent) patients, cardiac disease in ten (14 percent) patients, hyperventilation in 14 (19 percent) patients, and only 3 patients had extrathoracic disease causing dyspnea. Age younger than 40 years, intermittent dyspnea, and normal alveolar-arterial oxygen pressure difference (P(A-a)O2) at rest breathing room air was strongly predictive of bronchial hyperreactivity or hyperventilation. No patient diagnosed as having disease of the lung parenchyma or vasculature had a P(A-a)O2 less than or equal to 20 mm Hg. The differential diagnosis to explain dyspnea in patients with nondirective histories, normal findings from physical examinations, normal chest roentgenograms, and normal spirograms is extensive. The patient's age and measurement of gas exchange at rest help to formulate a diagnostic approach.
Address: Section of Pulmonary and Critical Care Medicine, Virginia Mason Medical Center, Seattle, Washington.
UI: 92036622
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