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Pol. Merkur. Lek (Pol. Med. J.), 2015, XXXIX/232: 248-250 Maximize

Pol. Merkur. Lek (Pol. Med. J.), 2015, XXXIX/232: 248-250

Title: Ventilatory disorders in patients with chronic heart failure 

Authors: Grzywa-Celińska A, Dyczko M, Rękas-Wójcik A, Szmygin-Milanowska K, Witczak A, Ostrowski S, Barud W, Mosiewicz J.

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SUMMARY IN POLISH & ENGLISH. FULL ARTICLE ONLY IN POLISH.

Ventilatory disorders in patients with chronic heart failure


Grzywa-Celińska A1, Dyczko M2, Rękas-Wójcik A2, Szmygin-Milanowska K1, Witczak A2, Ostrowski S2, Barud W2, Mosiewicz J2.

Medical University of Lublin, Poland: 1Chair and Department of Pneumonology, Oncology and Allergology; 2Chair and Department of Internal Medicine

Chronic heart failure (CHF) is a condition in which both structure and functional capacity of cardiac muscle are impaired, resulting in ineffective peripheral tissue perfusion. Affecting numerous organs and systems, it is currently considered to be a systemic illness. Among significant, however until now, hardly recognized consequences of CHF there are ventilatory disorders. Their presence may be explained by proximity of heart and lungs inside rib cage or by close functional cooperation between these two organs. Ventilatory disorders clinically manifest as exacerbations of the underlying disease, i.e. intense dyspnea – primarily exertional in nature, over time, present even at rest. On the basis of functional pulmonary tests, ventilatory disorders may be classified into three categories: restrictive, obstructive and most commonly – mixed. The restrictive model is represented in bodypletysmography as reduction in the total lung capacity to values less than 5th percentile of the predicted values for normals, while Tiffeneau index remains intact. Such condition may probably result from the chronic inflammatory process affecting lung tissue, for which the reaction of macrophage cells to both pulmonary stasis, as well as increased volume of interstitial and alveolar fluid remains the underlying cause. The increased formation of connective tissue fibers engenders thickening of alveolar-capillary membrane, occurrence of disturbed oxygen diffusion and emergence of hypoxemic respiratory failure. Ventilatory disorders of obstructive nature are characterised by reduction of Tiffeneau index – the calculated ratio between forced expiratory volume in 1. second and forced vital capacity – to values below 5th percentile of the predicted range. The research results indicate for the presence of bronchiolar narrowing – dominant in small-diameter bronchi and bronchioles, with larger structures being unaffected – clearly depicted in spirometry as reduced levels of forced expiratory flow after exhaling 50% and 75% of forced vital capacity. Due to a considerable epidemiological problem, as well as significance of the clinical symptoms manifesting ventilatory disorders in course of chronic heart failure, there should be put emphasis on cardiac injury prevention in individuals from risk groups and the proper treatment of patients already suffering from chronic heart failure.

Key words: Chronic heart failure, ventilatory disorders, obturative disorders, resctictive disorders

Pol Med J, 2015; XXXIX (232); 248–250