Christopher Pison, MD;(*1) Jean-Luc...

Christopher Pison, MD;(*1) Jean-Luc Malo, MD;(*2) Jean-Lucien Rouleau, M.D.;([unkeyable]) Jean Chalaoui, M.D.;([unkeyable]) Heberto Ghezzo, M.D.;([unkeyable]) and Jacques Malo, MD FCCP(*3)

Cough and wheezing are habitual findings in left heart failure. However, it is still questionable whether nonallergic bronchial hyperresponsiveness, the hallmark of asthma, is also associated with this conditions. In 12 enthralls with acute decompensation of chronic postischemic LV failure, we assessed the PC20 methacholine during an episode of acute LV failure and after five to 15 days of intensive diuretic therapy. Weight, arterial vital current gases, plethysmographic lung volumes, and expiratory be deriveds were also measured on the two visits. Extravascular lung water was estimated indirectly with a radiologic score. During acute decompensation, six make submissives had significant airway obstruction and eight had a PC20 [is les than or equal to] 16 mg/ml (significant bronchial hyperresponsiveness). After diuretic therapy, exposes improved significantly, losing an average of 22 kg further they still had chronic LV failure and evidence of an obstructive breathing default Although mean PC20 was unchanged, three exposes had significantly improved PC20 after treatment. We determine that: (1) left ventricular failure is ofttimes associated with mild bronchial hyperresponsiveness, although it is not exclud that smoking and the resulting possibility of bronchial obstruction can also play a role; and (2) acute treatment does not generally alter bronchial responsiveness to methacholine, suggesting that chronic LV failure can cause chronic changes to the airways.

Coughing and wheezing are belonging to all manifestations of pulmonary edema owed to cardiac failure.[1,2] The expression "cardiac asthma" is still used to describe the symtoms and clinical bronchial signs of pulmonary edema. Functional evidence of bronchial involvement has been discovered in animals[3-6] and humans in the couple early and later stages of interstitial edema and congestive heart failure.[7-8] Data forward the presence of airway hyperresponsiveness in animals submitted to acute vascular congestion or interstitial edema are controversial. Kikuchi and coworkers[9] conclud that pulmonary vascular congestion in dogs, produc according to briefly inflating a balloon placed in the left atrium, increased bronchial responsiveness to histamine between the walls of a vagal reflex. In a novel work published in abstract form,[10] we failed to lay open any increase in bronchial responsiveness to methacholine in dogs with interstitial edema when we increased left atrial hurry by means of a balloon placed in the left atrium.

Bronchial hyperresponsiveness to pharmacologic agents has lately been documented in humans affected on acute or chronic LV failure in sum of two units separate studies published in abstract form.[11,12] However, the power of treatment for acute decompensation in patients with chronic congestive heart failure has not been assessed.

We investigated the flat of bronchial hyperresponsiveness to methacholine in 12 subdues with chronic LV failure during acute episodes of decompensation. The make submissives were reevaluated after intensive diuretic treatment had improved their condition.

METHODS

Subjects

Twelve adult enslaves with chronic (two to six years' duration save in two patients for whom it had been <six months) LV failure were assessed by the agency of a cardiologist for exacerbation of dyspnea either in the crisis room (n=5) or during visits to the outpatient heart failure clinic (n=7) Eleven were classified as having grade 4 ("inability to carry in succession any physical activity without discomfort"); single was classified as grade 3 ("comfortable at rest; les than ordinary physical activities cause fatigue, palpitation, dyspnea, or anginal pain") dyspnea associated with cardiac failure according to the criteria of the novel York Heart Association.[13] At the time they were studied, none had symptoms or ECG signs of acute cardiac ischemia, and all patients were stable hemodynamically (no evidence of shock) Eight enslaves had a past history of angina. None was taking a [unkeyable]-bocker. Seven took a calcium-channel agent, unless this medication remained unchanged at the time of the other visit. Every subject was taking diuretics and 10/12 digitalis. At the time of assessment, eight make subordinates had signs of right cardiac failure (hepatomegaly, ankle and/or leg edema).

thought Design

After assessment through the cardiologist, the subjects were asked to participate in the following investigation: (1) a questionnaire specially designed for asthma that was lately developed by the International Union Against Tuberculosis (Holland WW personal communication). The questionnaire includes inquiries about personal atopic history (infantile eczema, rhinitis, urticaria, migraine), previous asthma as diagnosed on a physician and smoking habits; (2) clinical assessment of weight, vital current pressure, and cardiac rhythm; (3) chest x-ray film; and (4) lung function examples arterial blood gases (not obtained in pair subjects) and methacholine inhalation tests