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What Causes Shortness Of Breath And Chest Pain In An Elderly Person?

Posted on Tue, 17 Oct 2017

Question: A 78-year-old man is admitted to the hospital with the chief complaint of shortness of breath. He states the shortness of breath has been increasing over the past 2 months and is aggravated by exertion. He has found that he often awakens at night with a sensation of smothering that is partially relieved when he gets up and opens the window. He has not had ankle swelling or edema noted.
Past medical history is only positive for MI 8 years ago. He currently does not have complaints of chest pain.
BP is 140/98. When the nurse listens to his heart, she hears a normal S1 and S2 with a rate of 88. When listening to the lungs, the nurse notes bibasilar crackles. There is no peripheral edema.

Can you Describe the pathophysiology of left-sided heart failure.

Answered by Dr. Vasudha (2 hours later)

Brief Answer:
The pathophysiology in simple words as follows.

Detailed Answer:
Hi Walvesmt,
Thanks for the query.
- Mitral valve connects & controls flow of oxygenated blood from left atrium to left ventricle...( which has been forwarded from lungs after oxygenation of blood ) The patient has history of Mitral incompetence since 8 years. The condition results in back regurgitation of blood from left ventricle to left atrium making less fresh available for circulation in body.
- In early phases of the condition this deficit is compensated & patient remains symptom free for few years.But constant stress caused by this back pressure results in weakness of heart muscles on left side & symptoms of left sided failure start showing.
Being uncompensated... the blood starts back flowing ( Left ventricle to left atrium to lungs) ... this results in congestion of blood in lungs... edema in lung tissue..breathlessness & basal crackles.... dry cough. The short breath & fatigue follow as there is lesser oxygenated blood available in body functions.
Short breath & breathlessness is predominant in nights ( due to sleeping posture & is eased when patient gets up & finds more fresh air ( by opening the window ), the air hunger.
Edema feet & breathlessness are evident at later stage of the left failure ( due to plural effusion- water collection in plural cavity.
* your patient seems to have early symptoms of complications of Mitral Incompetence ( as he has just short breath / fatigue& night attacks of smothering )... through cardiovascular check up & treatment in time would save him from more severe turn in the condition.Advised to consult treating cardiologist.
Hope that answers your query. Any follow up query is welcome,
Wishing him a swift recovery, Thank you.

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Vasudha (37 minutes later)

Which of the clinical manifestations given in the case would be found in a patient with left-sided heart failure?

Answered by Dr. Vasudha (1 hour later)

Brief Answer:
The information as follows-

Detailed Answer:
Hi xxxxxxxxxx
Thanks for the query.
The clinical manifestations in given case that are found in left sided heart failure are-
1. Being a diagnosed patient of MI over 8 years & presence mild high blood pressure predisposes him to left sided heart failure.
2.Short breath since 2 months .. increasing over the period & aggravated by exertion,
3.Awakening in night due to smothering, relieved by getting up & opening the window is typical of left sided heart failure.
4. Crackles at bases of both lungs heard on auscultation
I hope that satisfies you. Any more information you want, please feel free to ask.
Thanks.

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. Vasudha (10 minutes later)

What symptoms would occur if right-sided failure was present also?

Answered by Dr. Vasudha (16 minutes later)

Brief Answer:
Symptoms of accompanying right sided heart failure are as follows.

Detailed Answer:
Hi,
Thanks for the follow up query,
When there is right sided failure of heart also- apart from weakness, short breath,fatigue there would be -
-edema feet/ ankles,
-palpitations,irregular heat beats,
-Enlarged neck veins,
- more urination in night,
- fainting.
I hope that helps.
Please grade the answer before you close the query.
Thanks.

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. Vasudha (13 minutes later)

Thank you so much for your help.

Answered by Dr. Vasudha (4 hours later)

Brief Answer:
Thanks a lot.

Detailed Answer:
Hi xxxxxxxx
I am happy to know that the answers have been useful to you.Thank you for the feed back, Such feed backs do increase our enthusiasm to answer more & more queries & thereby help more people.
I would like to answer health concerns you or your near acquaintances have.
I would be available on Health Care magic.com.
I wish an earliest medical evaluation & specific management for the patient.please convey my best wishes for fast recovery to him.
Thank you

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Above answer was peer-reviewed by : Dr. Nagamani Ng