1/12. theophylline therapy for near-fatal cheyne-stokes respiration. A case report.BACKGROUND: cheyne-stokes respiration is characterized by periodic breathing that alternates with hypopnea or apnea. OBJECTIVE: To describe the effect of theophylline on near-fatal cheyne-stokes respiration. DESIGN: Case report. SETTING: Tertiary referral center. PATIENT: A 48-year-old diabetic woman with a history of three cardiorespiratory arrests, a normal coronary arteriogram, normal left ventricular function, and severe cheyne-stokes respiration. MEASUREMENTS: oxygen saturation, intra-arterial blood pressure, central venous pressure, chest wall movement, electrocardiography, electromyography, electroencephalography, electro-oculography, minute ventilation, arterial blood gases, and serum theophylline levels. RESULTS: After intravenous administration of 1.2 mg of theophylline at 0.6 mg/kg per hour (serum level, 5.6 microg/mL), both cheyne-stokes respiration and oxygen desaturation were markedly attenuated. After infusion of 2.4 mg of theophylline (serum level, 11.6 microg/mL), cheyne-stokes respiration resolved completely. No change was seen with placebo. cheyne-stokes respiration did not recur during outpatient treatment with oral theophylline. CONCLUSION: theophylline may be a rapid and effective therapy for life-threatening cheyne-stokes respiration.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/12. Congestive heart failure and continuous positive airway pressure therapy: support of a new modality for improving the prognosis and survival of patients with advanced congestive heart failure.Nasal continuous positive airway pressure therapy has recently been studied as a nonpharmacologic adjunct to congestive heart failure therapy. In patients with congestive heart failure, it was reported that continuous positive airway pressure therapy for the condition cheyne-stokes respiration with central sleep apnea led to long-term improvements in cardiac function and alleviation of heart failure symptoms. cheyne-stokes respiration with central sleep apnea is a frequent breathing disorder well described in patients with congestive heart failure, and is an associated risk factor for increased cardiovascular morbidity and mortality. These apneas cause an increase in sympathetic nervous system activity, which would maintain afterload at a high level or tend to increase it with time, leading to further compromise of ejection fraction. continuous positive airway pressure appears to benefit the failing heart by increasing intrathoracic pressure, which is believed to cause an increase in cardiac output by decreasing the pressure gradient across the heart wall and allowing the left-ventricular end diastolic volume to decrease, thereby reducing the afterload. This beneficial "resting" of the heart has been documented to increase left-ventricular ejection fraction, increase cardiac index, improve inspiratory muscle strength, lower blood pressure and heart rate, decrease plasma and overnight urinary levels of norepinephrine, lower levels of atrial natriuretic peptide and endothelin-1, and increase heart rate variability. Other benefits include improvement in new york Heart association functional class status and improvement in dyspnea.- - - - - - - - - - ranking = 5keywords = pressure (Clic here for more details about this article) |
3/12. Improvement of cheyne-stokes respiration, central sleep apnea and congestive heart failure by noninvasive bilevel positive pressure and medical treatment.A 57-year-old man was admitted with dyspnea. Clinical evaluation revealed atrial fibrillation and congestive heart failure (CHF). Standard medical therapy of CHF failed to completely improve the dyspnea and polysomnography revealed cheyne-stokes respiration with central sleep apnea (CSR-CSA). He was equipped with noninvasive positive pressure ventilation (NPPV) with bilevel positive airway pressure (BiPAP). The combined therapy of medical treatment of the CHF and administration of NPPV with BiPAP reduced the CSR-CSA. This regimen resulted in marked improvement of cardiac function, evaluated by echocardiography, and reduction of plasma concentration of brain natriuretic peptide. After the patient recovered from CHF and was discharged from hospital, he continued to use NPPV with BiPAP at home. In patients with CHF, it is important to be aware of sleep-related breathing disorders because treatment will not only improve the hypoxemia, but also the cardiac dysfunction.- - - - - - - - - - ranking = 3keywords = pressure (Clic here for more details about this article) |
4/12. cheyne-stokes respiration, periodic circulation, and pulsus alternans in spinal cord injury patients.STUDY DESIGN: case reports. OBJECTIVES: To describe cheyne-stokes respiration (CSR) and associated circulatory abnormalities in three patients with spinal cord lesions. SETTING: veterans Administration Hospital, USA. SUBJECTS: One paraplegic patient with coronary artery disease in congestive heart failure, one tetraplegic patient with alcoholic cardiomyopathy and postural hypotension, and one tetraplegic complete patient with cardiomegaly, severe aortic atherosclerosis, and postural hypotension. methods: Breathing activity was measured with a nasal thermistor or abdominal stretch transducer. Cardiac activity was estimated with a photoelectric sensor for cutaneous blood flow placed on the forehead or a piezoelectric transducer for pressure positioned over an artery or the cardiac apex. Tracings were drawn on a strip chart recorder. The subjects were at rest in semireclining positions. RESULTS: Survey times were 17-21 min, and cycling periods were 41-72 s. Periodic changes in the depth of breathing were accompanied by periodic changes in amplitude of forehead cutaneous pulse, blood pressure, or apical cardiac impulse in all patients. Peak circulation occurred at or following peak respiration. In addition, cyclical pulsus alternans occurred in two patients. CONCLUSION: Three spinal cord injury patients sustained CSR and circulatory periodicity associated with cardiac disease and postural hypotension.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
5/12. cheyne-stokes respiration in congestive heart failure: continuous positive airway pressure of 5-8 cm H2O for 1 year in five cases.Five adult patients with congestive heart failure (CHF) due to dilated cardiomyopathy complicated by cheyne-stokes respiration/central sleep apnea (CSR/CSA) were treated with continuous positive airway pressure (CPAP) with an initial pressure of 5 cm H2O. Four patients were followed up for 12 months with CPAP of 5 cm H2O. The rest, a 93-year-old patient, was followed up for 30 months, and the CPAP was reset at 8 cm H2O due to worsened cardiac function after 6 months and it was reset at 6 cm H2O due to dryness of the nose after 23 months. For all the patients with nightly CPAP use for 6.0 /-1.4 h per day for a year, frequency of CSR/CSA was significantly reduced after 3 and 12 months with CPAP (p<0.05). Moreover, their symptoms, cardiac function and sleep quality were significantly improved after 3 months (p<0.05), and were maintained above the pre-CPAP levels after 12 months, except for the oldest patient whose cardiac function tended to deteriorate. The results suggest that CSR/CSA in CHF can be treated with CPAP set at a lower pressure than the conventional method, and that CPAP at 5-8 cm H2O is often effective in eliminating CSR/CSA, improving sleep quality, and presumably maintaining cardiac function.- - - - - - - - - - ranking = 3.5keywords = pressure (Clic here for more details about this article) |
6/12. First experience of using new adaptive servo-ventilation device for cheyne-stokes respiration with central sleep apnea among Japanese patients with congestive heart failure: report of 4 clinical cases.BACKGROUND: cheyne-stokes respiration with central sleep apnea (CSR-CSA) in congestive heart failure (CHF) is generally considered a poor prognostic indicator, but treatment of CSR-CSA using an adaptive servo-ventilation (ASV) device has been developed. This is the first evaluation of its use in the management of CSR-CSA in Japanese CHF patients. methods AND RESULTS: Four CHF patients with CSR-CSA that was unresponsive to conventional positive airway pressure (CPAP) underwent 3 nights of polysomnography: baseline, CPAP or bi-level PAP, and on the ASV. The apnea - hypopnea index (AHI) and central-AHI (CAHI) were markedly improved on ASV (AHI 62.7 /-10.1 to 5.9 /-2.2 /h, p=0.0006, CAHI 54.5 /-6.7 to 5.6 /-2.3 /h, p=0.007). In addition, the sleep quality improved significantly on ASV, including arousal index (62.0 /-10.5 to 18.7 /-6.2 /h, p=0.012), percentage of slow-wave sleep (2.6 /-2.6 to 19.4 /-4.8 %, p=0.042). CONCLUSIONS: ASV markedly improved CSR-CSA in patients with CHF. It is a promising treatment for Japanese patients with CHF.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
7/12. Novel insights on effect of atrioventricular programming of biventricular pacemaker in heart failure--a case series.BACKGROUND: echocardiography plays an integral role in the diagnosis of congestive heart failure including measurement of left heart pressure as well as mechanical dyssynchrony. methods: In this report we describe novel therapeutic uses of echo pulsed wave Doppler in atrioventricular pacemaker optimization in patients who had either not derived significant symptomatic benefit post biventricular pacemaker implantation or deteriorated after deriving initial benefit. In these patients atrioventricular optimization showed novel findings and improved cardiac output and symptoms. RESULTS: In 3 patients with Cheyne Stokes pattern of respiration echo Doppler showed worsening of mitral regurgitation during hyperpneac phase in one patient, marked E and A fusion in another patient and exaggerated ventricular interdependence in a third patient thus highlighting mechanisms of adverse effects of Cheyne Stokes respiration in patients with heart failure. All 3 patients required a very short atrioventricular delay programming for best cardiac output. In one patient with recurrent congestive heart failure post cardiac resynchronization, mitral inflow pulse wave Doppler showed no A wave until a sensed atrioventricular delay of 190 ms was reached and showed progressive improvement in mitral inflow pattern until an atrioventricular delay of 290 ms. In 2 patients atrioventricular delay as short as 50 ms was required to allow E and A separation and prevent diastolic mitral regurgitation. All patients developed marked improvement in congestive heart failure symptoms post echo-guided biv pacemaker optimization. CONCLUSION: These findings highlight the value of echo-guided pacemaker optimization in symptomatic patients post cardiac resynchronization treatment.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
8/12. Cyclic haemodynamic and arterial blood gas changes during Cheyne-Stokes breathing.A 74-year-old patient presented with congestive heart failure and continuous periodic breathing. Left ventricular ejection fraction was 20% and the lung-to-brain circulation time was prolonged to 35 s. We report on the phasic changes of the patient's arterial blood gas tensions and on the periodic fluctuations of pulmonary artery pressures and cardiac output that we observed during Swan-Ganz catheterisation.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
9/12. sleep apnea in patients with left ventricular dysfunction: beneficial effects of nasal CPAP.Five patients with congestive heart failure (CHF) and 1 with left ventricular dysfunction but without CHF were found to have sleep apnea. Central sleep apnea (CSA) related to cheyne-stokes respiration was seen in 4 cases while obstructive sleep apnea (OSA) was seen in 2. All patients had symptoms of sleep apnea. Nasal continuous positive airway pressure (NCPAP) was effective in reversing CSA and OSA in all patients with improvement in sleep structure and alleviation of symptoms of sleep apnea. In addition, all experienced a reduction in cardiac dyspnea. This was associated with a 5% or greater increase in left ventricular ejection fraction while on NCPAP, compared to baseline value off NCPAP in 5 patients and resolution of chronic pleural effusion and pulmonary edema in the sixth. We conclude that cheyne-stokes respiration during sleep may give rise to a CSA syndrome that is reversible by NCPAP. In addition, NCPAP therapy may lead to a reduction in cardiac dyspnea and improvement in left ventricular function in patients with left ventricular dysfunction and sleep apnea.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
10/12. End-expiratory pressure best approximates intrinsic lower esophageal sphincter pressure. Report of a patient with cheyne-stokes respiration.Recent studies have shown that the respiratory oscillation inherent in the station pull-through technique of measuring lower esophageal sphincter (LES) pressure is the result of active diaphragmatic contraction. A recent study in cats suggested that intrinsic LES tone is best reflected by end-expiratory pressure during spontaneous respiration. This finding is confirmed in a patient we report with achalasia and Waldenstrom's macroglobulinemia who had Cheyne-Stokes breathing. LES pressure during periods of central apnea approximated end-expiratory pressure during periods of hyperpnea.- - - - - - - - - - ranking = 6keywords = pressure (Clic here for more details about this article) |
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