What type of heart failure is associated with dyspnea

Inhaled furosemide has been shown to decrease breathlessness and avoids the adverse effects of benzodiazepines and opiates. Professional societies do not yet endorse its use. Further studies are needed to clarify its position in the treatment of dyspnea. The evaluation and management of patients with dyspnea is an important skill and involves a comprehensive understanding of pathophysiology, thorough history taking and focused physical examination.

Providers seeking to understand the etiology of a patient's dyspnea must consider non-pulmonary causes and indirect effects of seemingly unrelated disease states or conditions. The correct and timely diagnosis of the cause of dyspnea can often be lifesaving given the critical importance of ventilation and oxygenation to survival of the patient. Considerations in Special Populations Conclusion References. American Thoracic Society Committee on Dyspnea. An official American Thoracic Society statement: update on the mechanisms, assessment, and management of dyspnea.

Qualitative aspects of exertional dyspnea in patients with interstitial lung disease. J Appl Physiol ; Qualitative aspects of exertional breathlessness in chronic airflow limitation: pathophysiologic mechanisms.

Exertional breathlessness in patients with chronic airflow limitation. The role of lung hyperinflation. Am Rev Respir Dis ; Cheng TO. Acute dyspnea on exertion is an angina equivalent. Int J Cardiol ; Undem BJ, Nassenstein C. Airway nerves and dyspnea associated with inflammatory airway disease. Respir Physiol Neurobiol ; Paintal AS. Sensations from J receptors. Physiology ; Relief of the 'air hunger' of breathholding.

A role for pulmonary stretch receptors. Respir Physiol ; Relationship between ventilation and breathlessness during exercise in chronic obstructive airways disease is not altered by prevention of hypoxaemia. Clin Sci ;. Dyspnea: a sensory experience. Lung ; Evans KC. Cortico-limbic circuitry and the airways: insights from functional neuroimaging of respiratory afferents and efferents. Biol Psychol ; Lancet ; Effect of mucolytic and expectorant drugs on tracheobronchial clearance in chronic bronchitis.

Eur J Respir Dis Suppl ; Oxygen may improve dyspnea and endurance in patients with chronic obstructive pulmonary disease and only mild hypoxemia. Effect of heliox on lung dynamic hyperinflation, dyspnea, and exercise endurance capacity in COPD patients. In HF, paroxysmal nocturnal dyspnea is caused by the decreased ability of the heart to fill and empty, producing high pressure in the blood vessels around the lung.

Some studies investigating the sensitivity and specificity of dyspnea for HF found low sensitivity and high specificity results, but these were not compared with the COPD. The association between anxiety, depression and respiratory symptoms is an evidence widely described in literature.

In our study we observed that independent associations between each disease heart failure or depression and dyspnea were similar, a framework that changed when the two diseases were considered individually in relation to PND. Its association to HF was greater. Anxiety and depression can increase the intensity of dyspnea creating an impaired cardiac function and may contribute to the disability rate associated with dyspnea. Although the prevalence of asthma was greater than the prevalence of COPD in this study, its association with the three types of dyspnea was less pronounced.

In this study, of the 52 patients with self-reported HF, Asthma, more recognized as a disease of childhood and young adults, is sub-diagnosed in older people and can be confused with COPD and HF. In both asthma and COPD there is an increase in airway resistance for exhalation leading to dyspnea, and so, it is difficult to differentiate COPD and asthma in clinical practice, especially in a primary care environment.

Thyroid disease, angina and infarction, also self-reported conditions, showed a similar pattern of association between them: clear crude and statistically significant associations with dyspnea on exertion, orthopnea, and PND.

Patients who experience an acute myocardial infarction often describe discomfort in the retrosternal region and inability to catch their breath. This sensation is secondary to the reduced cardiac output and pulmonary perfusion and is caused by decreased myocardial ischemic contractility. This study used the self-report practice to define the presence of dyspnea and the disease, including heart failure.

No diagnosis of thyroid disease, asthma, angina, myocardial infarction and COPD have been done in the Digitalis Study, so, to preserve uniformity in the definition of variables, we opted to use the same criteria self-report for HF, even although its diagnosis was available.

The accuracy of self-report of chronic diseases is usually satisfactory. The prevalence was 8. Studies report that older people, women, and white individuals are more likely to report diseases, including HF. The present study has other limitations besides the fact that the diseases were self-reported, as discussed above. Its cross-sectional design prevents it from establishing dyspnea as a consequence of the diseases studied.

On the other hand, the low prevalence of certain diseases caused some biologically plausible associations to not reach the significance level of 0. With the results obtained on the diseases most strongly associated with the three types of dyspnea included in the study, it can be concluded that the HF, COPD and depression, even individually, were associated with dyspnea on exertion and orthopnea.

It can also be concluded that the association of these pathologies with dyspnea allowed us to see more clearly the existence of connection or not to the respiratory disorder.

The different behavior of the associations of the types of dyspnea with the major chronic diseases of patients in primary health care can help in the better characterization of patients with HF.

However, it should be emphasized that clinical signs and symptoms of COPD, asthma, depression and HF, require careful interpretation by physicians in general for proper diagnosis and treatment.

Med Klin Intensivmed Notfmed. Diagnosis of heart failure in older adults: predictive value of dyspnea at rest. Arch Gerontol Geriatr. Eur J Epidemiol. Eur J Heart Fail. Aten Primaria. Acute heart fail-ure: Epidemiology risk factors prevention.

Farmakis D. Parissis J. For example, they may stop walking up the stairs, or they may drive to the store instead of walking.

Some people at first deny that they have been experiencing this symptom. It is only after doctors ask them about changes in their activities that they realize they have been avoiding physical exertion. This decrease in your ability to exert yourself physically is what doctors call low exercise capacity.

People with heart failure often experience swelling in their ankles or feet. You might notice that:. The degree of swelling you experience depends on how well your body is compensating for heart failure and how much sodium and water your body retains. In some cases the swelling is mild and merely bothersome, while in other cases it can be severe and painful if the skin becomes taut and sensitive. The medical term for this swelling in the legs is pedal edema—"pedal" refers to the feet and "edema" refers to the buildup of excess fluid.

Heart failure often causes what doctors call "pitting edema," meaning that applying pressure to the swollen skin leaves an indentation in the skin. Doctors often test for edema by pressing their thumb to the skin and seeing whether it leaves an impression. You may see this yourself if you take off your shoes and socks and find that your socks have left an impression in the skin of your ankles and feet.

You may notice more severe swelling if you have been eating too much salt, which causes your body to retain fluid. Elevating your feet or wearing supportive stockings can help relieve the swelling. Weight gain may be the first noticeable sign that you have developed heart failure or that your heart failure is getting worse. The amount of weight gained varies greatly among people with heart failure, and it reflects the amount of sodium and water the body has retained.

A sudden weight gain may mean that excess fluid is building up in your body because your heart failure is getting worse. It is a symptom of sudden heart failure. Your doctor will probably ask you to weigh yourself every day. Know when to call your doctor if you suddenly gain weight.

Echocardiography is the mainstay for evaluating whether left-sided heart disease is the cause of dyspnea. If left-sided heart failure is diagnosed, this symptom complex must then be subjected to further etiological evaluation. Hypertensive, ischemic and valvular heart diseases are common, as well as atrial fibrillation.