Bradycardia

When the resting heart rate of an adult is less than 60 beats/ minute, the condition is termed as bradycardia. Clinical symptoms generally appear when the heart rate goes below 50 beats/ minute.
In case of atheletes the heart rate may be even below 50 beats/ minute.

Causes-

1. Normal esp in athletes, young healthy individuals
2. Medications - Calcium channel blockers, beta blockers, digitalis, clonidine, amiodarone, anti-arrhythmic drugs.
3. Sick sinus syndrome
4. Vaso vagal response
5. Hypothermia
6. Hypothyroidism
7. Arterioventricular blocks.
8. Myocardial ischaemia involving right coronary artery.
9. increased intracranial pressure (Cushing's reflex)
10. Cardiac infiltrative diseases - amyloidosis, sarcoidosis, hemochromatosis.

Cough - Chronic

Common causes- Post nasal drip, Asthma, Gastroesophageal reflux disease.
Pulmonary infections-

1. Post viral
2. Bronchitis esp in smokers
3. Bronchiectasis
4. Tuberculosis
5. Cystic fibrosis
6. Mycobacterium avium complex
7. pertusis
8. mycoplasma
9. Respiratory synctial virus
10. Parasites- ascaris

Pulmonary non infections-

1. Asthma
2. beta blockers causing asthma
3. chronic obstructive pulmonary disease - COPD
4. Ace inhibitors
5. irritant inhalation- smoking
6. endotracheal lesions- tumors
7. Interstitial lung disease
8. Sarcoidosis
9. Chronic microaspiration

Non pulmonary causes-

1. Gastroesophageal reflux disease
2. Post nasal drip
3. Sinusitis
4. Congestive Cardiac Failure
5. laryngitis
6. Eustachian tube or tympanic membrane infections
7. Psychogenic or habit cough

Cough- Acute in onset

Cough may be acute in onset or chronic.

Causes-

1. Viral Upper respiratory infection or post viral cough ( most common)
2. Bacterial upper respiratory infections
3. Allergic rhinitis ( post nasal drip)
4. Pneumonia
5. Pulmonary oedema e.g. congestive cardiac failures
6. Pulmonary embolism
7. Aspiration Pneumonia
8. Foreign body aspiration

Diagnostic flowchart for Chronic Dyspnea

Chronic dyspnea is defined as dyspnea lasting more than one month.

Indications for CT/HRCT include :

• restrictive lung disease.
• preoperative assessment of patients who are being referred for lung reduction surgery.
• patients who have dyspnoea and reduced single-breath diffusing capacity for carbon monoxide without evidence of airflow obstruction.
• patients with chronic dyspnoea in whom the initial evaluation (clinical assessment, CXR and pulmonary testing) is non diagnostic or non revealing.

Difficulty in breathing or Dyspnea

Dyspnea is uncomfortable awareness of breathing.
Or
Shortness of breath
Or
Difficulty in breathing

Causes:

Acute-

• Asthma
• Pneumonia
• Pulmonary edema
• Pneumothorax
• Pulmonary embolism
• metabolic acidosis
• Panic attacks

Pulmonary-

• Airflow obstruction diseases- Asthma, COPD, upper airway obstruction
• restrictive lung diseases- interstitial lung disease, pleural thickening or effusion, respiratory muscles weakness, obesity
• Pneumonia
• Pulmonary edema
• Pneumothorax
• Pulmonary embolism

Cardiac-

• myocardial ischaemia
• congestive heart failure
• valvular obstruction
• arrythmias
• cardiac tamponade

Metabolic-

• acidosis
• hypercapnia
• sepsis

Hematologic-

• anaemia
• methemoglobinemia

Psychiatric-

• anxiety

Episodic dyspnea can occur in following cases-

• congestive cardiac failure
• asthma
• acute or chronic bronchitis
• recurrent pulmonary emboli

Cyanosis

Bluish discoloration of skin and mucous membranes, resulting from increased amount of reduced hemoglobin or hemoglobin derivatives in the capillary blood.
Most marked in lips, nails beds, ears and malar eminence.
Causes-
A. central cyanosis

• Due to decreased arterial saturation

1. Cardiac causes-

• fallot's tetralogy
• Eisenmenger's syndrome
• congestive cardiac failure

    2.  Pulmonary causes-

• chronic bronchitis
• interstitial lung disease
• pulmonary arteriovenous fistula

   3.  High altitude

   4.   Cirrhosis of liver

• Due to abnormal hemobglobin derivatives

1. Methemoglobinemia
2. sulphahemoglobinemia

B. Peripheral cyanosis

1. due to diminished blood flow resulting from decreased cardiac output

• Mitral stenosis
• caongestive cardiac failure
• shock

     2.   due to local vasoconstriction

• cold exposure
• raynaud's disease
• peripheral vascular disease

Three of the same kind still different

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Chest Pain

Common Causes

1. Cardiac Causes:

• Angina Pectoris
• Myocardial Infarction
• Mitral Valve Prolapse
• Pericarditis
• Hypertrophic Cardiomyopathy

2. Lung and Pleura

• Pleurisy
• Pneumothorax
• Pulmonary embolism

3. Dissecting Aneurysm of Aorta

4. Oesophageal

• Reflux Oesophagitis
• Diffuse Oesophageal spasm

5. Musculoskeletal

6. Intraabdominal conditions

7. Anxiety state