Pickwickian syndrome

Published on 02/04/2015 by admin

Filed under Internal Medicine

Last modified 02/04/2015

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110 Pickwickian syndrome

Instruction

Look at this patient.

Salient features

History

• Daytime somnolence

• Unrefreshing sleep

• Daytime fatigue

• Snoring

• Shortness of breath

• Headache particularly in the morning

• Decreased libido

• Swelling of feet

• Poor concentration

• Systemic hypertension

• Family history of obesity

• Gastroesophageal reflux

• Poor quality of life

• History of stroke: obstructive sleep apnoea significantly increases the risk of stroke or mortality from any cause, and the increase is independent of other risk factors, including hypertension.

Examination

• Obese patient who is plethoric and cyanosed

• Maxillary or mandibular hypoplasia:

• Short of breath at rest
• May be nodding off to sleep.

• Systemic hypertenion

• Nocturnal angina

• Look for signs of pulmonary hypertension and right heart failure

• Tell the examiner that you would like to measure the neck circumference

Remember: Nearly 50% of patients with sleep apnoea syndrome are not obese.

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