Patterned Breathing

Differential Overview

❑ Tachypnea

❑ Paroxysmal nocturnal dyspnea

❑ Sleep apnea

❑ Cheyne-Stokes

❑ Kussmaul

❑ Biot

❑ Apneustic

❑ Ataxic

❑ Stertorous

Clinical Findings

Tachypnea  Although there are many pulmonary causes, the most important is pulmonary embolism, associated with leg swelling and pleuritic chest pain. Intense tachypnea is also seen with intracranial hemorrhage and metabolic acidosis due to sepsis or salicylate toxicity (Kussmaul, see below).

Paroxysmal nocturnal dyspnea  A patient with congestive heart failure reports awakening from sleep with air hunger and diaphoresis, and opens a window for fresh air. Cough often occurs during an episode.

Sleep apnea  Roommates note loud snoring with periods of apnea terminated by a gasping snore. Excessive daytime somnolence helps to differentiate sleep apnea from regular snoring. The patient is usually obese.

Cheyne-Stokes  Respiration periodically and sequentially increases in depth, then is followed by a 15 to 60 second period of apnea. This pattern is seen most commonly in severe congestive heart failure, but also in meningitis, brain tumor, pneumonia, hypoxia, altitude sickness, and stroke. Delayed feedback to central respiratory centers leads to loss of fine-tuning to changes in pCO₂. The circulation time from the lung to the CNS equals one-half the cycle length. A low pontine or upper medullary lesion will produce a Cheyne-Stokes pattern unresponsive to pCO₂. These patients will be cyanotic and have CO₂ retention. Oxygen will enhance this pattern whereas in classic Cheyne-Stokes, the pattern would be suppressed.

Kussmaul  It occurs as regular, deep, fast breathing without dyspnea in acute metabolic acidosis such as ketoacidosis, salicylate or methyl alcohol toxicity, or uremia. The respirations cannot be interrupted for speech so the patient must pause to breathe. This finding is of value in the differentiation of hypotensive shock, in which tachypnea favors sepsis rather than hypovolemia.

Biot  Irregularly irregular breathing abruptly starts and stops with longer periods of apnea than breathing. Seen in pontine lesions, Biot may precede respiratory arrest.

Apneustic  Bradypnea, in which the breath is held at end-inspiration, is most often a sign of pontine hemorrhage, but it may also occur in basilar artery occlusion, hypoglycemia, anoxia, or severe meningitis.

Ataxic  This appears as breathing with varying tidal volumes and rates, caused by a problem with medullary chemoreceptors, but under conscious control.

Stertorous  The cheeks puff in and out in a patient with increased intracranial pressure.

Book Source Details

• Book Title: Field Guide to Bedside Diagnosis
• Author(s): David S. Smith
• Year of Publication: 2007
• Copyright Details: Field Guide to Bedside Diagnosis, Copyright © 2007 Lippincott Williams & Wilkins.

Other Book Chapters Related to Breath odor

Read excerpts from these other book chapters related to Breath odor:

Copyright Details: Field Guide to Bedside Diagnosis, Copyright © 2008 Williams & Wilkins.

More About Causes of Breath odor

• Back to symptom: Breath odor: Introduction (review 121 causes)
• Next Book Extract About Breath odor: Breath odor, fecal (Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
• All Book Extracts: All Online Book Extracts for Breath odor

More About This Book: Title: Field Guide to Bedside Diagnosis Authors: David S. Smith Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 0-78178-165-5

 » Next page: Breath odor, fecal (Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)

Rate This Website

What do you think about the features of this website? Take our user survey and have your say:

Website User Survey

Medical Tools & Articles:

Next articles:

• Breath odor, fecal (Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
• Breath odor, fruity (Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
• Breath with fecal odor (Signs & Symptoms: A 2-in-1 Reference for Nurses)
• Breath with fruity odor (Signs & Symptoms: A 2-in-1 Reference for Nurses)
• Halitosis (Signs & Symptoms: A 2-in-1 Reference for Nurses)

Tools & Services:

• Bookmark this page
• Take a survey relating to Breath odor
• Symptom Search
• Symptom Checker
• Medical Dictionary
• Give your feedback

Medical Articles:

• Disease & Treatments Search
• Misdiagnosis Center
• Full list of interesting articles

Forums & Message Boards

• Ask or answer a question at the Boards:
• I cannot get a diagnosis. Please help.
• Tell us your medical story.
• Share your misdiagnosis story.
• What is the best treatment for my condition?
• See all the Boards.

Enter your search terms Submit search form
Search The Web Search wrongdiagnosis.com

Common Health Mistakes

Symptom
Checker

Search Specialists by State and City