Causes of orthopnoea

 CAUSES OF ORTHOPNEA :

1. Left ventricular failure.

2. Asthma

3. COPD

4. Bilateral diaphragmatic paralysis in the absence of heart disease.

Ref : Fraser 4th edition page no. 388

Breathlessness aggravating and relieving factors

 Breathlessness aggravated by exercise - exercise induced asthma

Aggravated by Pollens,dust,smoke,cold air, drugs, animals - Asthma 

Drugs- Aspirin,NSAIDs can aggravate breathlessness in asthmatics

Aggravated by lying down- orthopnea(relieved by sitting)- LV failure, large pleural effusion,massive ascites, morbid obesity and any severe lung disease.

Aggravated by sitting up- platypnea (relieved by lying down)- ASD, patent foramen ovale, large intrapulmonary shunt,hepatopulmonary syndrome 

Aggravated by lying on oneside - trepopnea

Due to large unilateral lung disease(patient prefers healthy lung down), dilated cardiomyopathy (pt prefers right side down)

Tumors compressing major airways/blood vessels 

Referrence - Macleod's 13 th edition 

Respiratory system page no-142

Monkey pox -etiology and drug of choice

Monkey pox 

 

Etiology :Poxviruses are a family of double-stranded DNA viruses whose genomic structure is generally conserved across subfamilies, genera, and species.

Most poxviruses that infect humans are spread through contact, not  by respiratory route 

Patient usually presents with nodular or vesicopustular lesions ,fever ,followed by rash,centrifugal distributionprominet in palms and soles

 

 Treatment :mainly supportive and prevent secondary bacterial infection

Recently u.s FDA approved the anti viral drug Tecovirmat (Tpoxx) has been used.

Brincidofovir (tembexa)also approved by FDA

Ref : Harrison principal of internal medicine 

Indications of Aerobika

 Indications of AEROBIKA

COPD

Cystic fibrosis

Bronchiectasis

Bronchial asthma

Bronchiolitis obliterans

Relative contraindications to Aerobika

Untreated pneumothorax

Intracranial pressure > 20mm Hg

Active haemoptysis

Recent trauma or surgery to skull, face, mouth, or oesophagus

Patient with acute asthma attack or acute worsening of Chronic Obstructive Pulmonary Disease (COPD) unable to tolerate increased work of breathing

Acute sinusitis or epistaxis

Tympanic membrane rupture or other known or suspected inner ear pathology

Nausea

Source- aerobika user guide

https://www.aerobika.us/wp-content/uploads/2018/10/patient-user-guide-en.pdf? 1

Chromogranin A

 Chromogranin A (CgA) is a constituent of neuroendocrine vesicles and catecholamine storage vesicles . Neuroendocrine cancer , like small cell carcinoma of lung has been found to have CgA secretion and hence used as a tumor marker . It has been used as a marker for disease progression and can also be demonstrated in immunohistochemistry of Neuroendocrine tumors .