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“I can’t breathe”: The Challenge of Dyspnea. Physiology and Pathophysiology Pawandeep Brar MD Palliative Care Physician Temmy Latner Centre for Palliative Care Mount Sinai Hospital. Objectives. Review causes of dyspnea To review normal respiratory cycle

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i can t breathe the challenge of dyspnea

“I can’t breathe”: The Challenge of Dyspnea

Physiology and Pathophysiology

PawandeepBrar MD

Palliative Care Physician

TemmyLatner Centre for Palliative Care

Mount Sinai Hospital

objectives
Objectives
  • Review causes of dyspnea
  • To review normal respiratory cycle
  • Review pathophysiology of dyspnea
physiology of respiration
Physiology of Respiration
  • Respiratory Centre in the medulla and pons coordinates activity of:
    • Diaphragm,
    • Intercostal Muscle
    • Accessory Muscles of Respiration
physiology of respiration1
Physiology of Respiration
  • Respiratory Centre receives sensory information from
    • Central and Peripheral Chemoreceptors
    • Peripheral Mechanoreceptors from muscles
    • Pulmonary Vagal Afferents
physiology of respiration2
Physiology of Respiration
  • Respiratory system designed to maintain homeostasis with respect to gas exchange (adequate oxygenation) & the acid-base status of the organism (adjust PaCO2 to maintain normal pH)
    • Derangements in oxygenation as well as acidemia lead to breathing discomfort
pathophysiology of dyspnea
Pathophysiology of Dyspnea
  • Pathophysiology of dyspnea is complex & multiple
  • Can break it down into 3 components
  • Work of Breathing: increase effort of breathing against increased resistance of breathing with weakened muscles (sensed through mechanoreceptors)
  • Chemoreceptors: sense hypercapnea and hypercarbia
  • Neuromechanical Dissociation: when there is a mismatch between what the brain desires for respiration and the sensory feedback it receives
take home points
Take Home Points
  • Respiratory system is a complex feedback loop designed to maintain homeostasis
  • Hypoxia is not the only factor in dyspnea
  • There is still much to be learned about the pathophysiology of dyspnea!