Bombay Hospital Journal ContentsHomeArchivesSearchBooksFeedback


Home > Table of Contents > Symptoms / signs / obsolete / evergreen / new
 
 
Symptoms / signs / obsolete / evergreen / new
 
A CCF Patient on Medical Treatment Complains of Dyspnoea at Night-What could be the Cause?
OP Kapoor
 
 

The following differential diagnosis should be thought of in a patient of CCF, who is on medical treatment and yet complains of dyspnoea at night.

  1. First and foremost, inadequate treatment, for example, inadequate dose of diuretics or digoxin and non-inclusion of drugs like third generation betablockers, ACE Inhibitors etc.
  2. Associated COPD is often missed especially because a smoker may have both a lung and heart disease.
  3. Patient having GORD (Gastro oesophageal reflux disease) may have bronchial irritation at night causing cough and dyspnoea.
  4. If theophylline is administered to patients with diagnosis of COPD along with CCF, it is worth remembering that this drug can increase GORD, and thus cough and dyspnoea.
  5. Attacks of Cheyne’s Stoke breathing.
  6. Patient may have sleep apnoea syndrome and abnormal breathing at night may be due to heavy snoring.
 
Ex. Hon. Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.
 
 

SEVERITY OF ACUTE ILLNESS PREDICTS POST-INFECTIVE FATIGUE SYNDROME

The severity of acute illness is a key risk factor for post-infective fatigue syndrome, rather than sex, age, or psychological factors. The syndrome represents a stereotyped outcome from several viral and non-viral infections. Hickie and colleagues followed more than 250 patients with Epstein-Barr virus, Coxiella burnetti, or Ross River virus at regular intervals in a year from the time of acute infection, using self report, structured interview, and clinical assessment. A relatively uniform post-infective fatigue syndrome persisted for six months or more in a significant minority of patients.

BMJ, 2006; 333 : 575.
 
Top