Acute breathlessness

2018 ◽  
Author(s):  
Jonathan Timperley ◽  
Sandeep Hothi
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Embolism ◽  
Older Patients ◽  
Decompensated Heart Failure ◽  
Chronic Obstructive ◽  
Clinical Approach ◽  
Obstructive Pulmonary Disease ◽  
New Onset

Acute breathlessness or dyspnoea is the new onset of an unpleasant awareness of breathing, at rest or at a level of exercise, which did not previously cause symptoms. It is often associated with other symptoms—including wheeze, cough, chest pain, and palpitation—which, together with the patient’s comorbidities, help shape the differential diagnosis. Five disorders—decompensated heart failure, exacerbations of asthma or chronic obstructive pulmonary disease, pneumonia, and pulmonary embolism—account for 80% of diagnoses. In older patients, acute breathlessness often results from multiple interrelated pathologies (e.g. pneumonia on a background of COPD, triggering acute atrial fibrillation). This chapter describes the clinical approach to the patient presenting with acute breathlessness.

Characteristics and outcomes of adults with chronic obstructive pulmonary disease and atrial fibrillation

Heart ◽  
2018 ◽  
Vol 104 (22) ◽  
pp. 1850-1858 ◽  
Author(s):  
Michael T Durheim ◽  
DaJuanicia N Holmes ◽  
Rosalia G Blanco ◽  
Larry A Allen ◽  
Paul S Chan ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Symptom Burden ◽  
Smoking History ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease

ObjectiveChronic obstructive pulmonary disease (COPD) is associated with the development of atrial fibrillation (AF), and may complicate treatment of AF. We examined the association between COPD and symptoms, quality of life (QoL), treatment and outcomes among patients with AF.MethodsWe compared patients with and without a diagnosis of COPD in the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation, a prospective registry that enrolled outpatients with AF not secondary to reversible causes, from both academic and community settings.ResultsAmong 9749 patients with AF, 1605 (16%) had COPD. Relative to patients without COPD, those with COPD were more likely to be older, current/former smokers (73% vs 43%), have heart failure (54% vs 29%) and coronary artery disease (49% vs 34%). Oral anticoagulant and beta blocker use were similar, whereas digoxin use was more common among patients with COPD. Symptom burden was generally higher, and QoL worse, among patients with COPD (median Atrial Fibrillation Effect on QualiTy-of-Life score 76 vs 83). Patients with COPD had higher risk of all-cause mortality (adjusted HR 1.52 (95% CI 1.32 to 1.74)), cardiovascular mortality (adjusted HR 1.51 (95% CI 1.24 to 1.84)) and cardiovascular hospitalisation (adjusted HR 1.15 (95% CI 1.05 to 1.26)). Patients with COPD also had higher risk of major bleeding events (adjusted HR 1.25 (95% CI 1.05 to 1.50)). There did not appear to be associations between COPD and AF progression, ischaemic events or new-onset heart failure.ConclusionsAmong patients with AF, COPD is associated with higher symptom burden, worse QoL, and worse cardiovascular and bleeding outcomes. These associations were not fully explained by cardiovascular risk factors, AF treatment or smoking history.Clinical registration numberNCT01165710

scholarly journals Cardiovascular and chronic obstructive pulmonary diseases: pathophysiological processes and treatment tactics

2020 ◽  
Vol 92 (3) ◽  
pp. 78-83
Author(s):  
L. G. Ambatiello ◽  
I. E. Chazova
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Chronic Obstructive Pulmonary Disease ◽  
Lifestyle Changes ◽  
Pulmonary Diseases ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Chronic Obstructive Pulmonary Diseases ◽  
Close Relationship ◽  
Global Aging

Due to the global aging of the population, the deteriorating ecology and lifestyle changes, patients with isolated cardiovascular diseases (CVD) are becoming less common, and the portrait of a comorbid patient comes first in the structure of patients with CVD. Among a number of diseases complicating and concomitant with cardiovascular, a special place is occupied by chronic obstructive pulmonary disease (COPD). The prevalence of COPD among CVD patients can reach 60%. Many of the pathophysiological mechanisms underlying COPD can increase the risk of cardiovascular disease and vice versa. The most common cases of COPD are arterial hypertension, coronary heart disease, heart failure, and atrial fibrillation. Given the close relationship between COPD and CVD, it is clear that treatment for one condition can affect another. This review discusses current positions about the influence of both groups of diseases on each other, and also observes the effects of drug therapy of both diseases.

scholarly journals Evaluation of diagnostic criteria of heart failure in patients with atrial fibrillation and chronic obstructive pulmonary disease

Kardiologiia ◽  
2019 ◽  
Vol 59 (10S) ◽  
pp. 4-12
Author(s):  
T. A. Dzyurich ◽  
A. I. Chesnikova ◽  
V. P. Terentyev ◽  
O. E. Kolomatskaya ◽  
V. A. Safronenko
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Clinical Symptoms ◽  
Chronic Obstructive ◽  
Right Heart ◽  
Obstructive Pulmonary Disease ◽  
Left And Right

Aim. Assess the diagnostic significance of markers of heart failure, to identify the features of clinical symptoms and structural and functional remodeling of the left and right heart in patients with chronic heart failure (CHF) in combination with atrial fibrillation (AF) and chronic obstructive pulmonary disease (COPD). Materials and methods. groups of patients were formed: group 1 – patients with COPD without cardiovascular diseases (n=28), group 2 – patients with CHF and COPD without AF (n=30), group 3 – patients with CHF and AF without COPD (n=33), group 4 (main) – patients with CHF, AF and COPD (n=29). Patients were evaluated for clinical symptoms, 6-minute walk test, echocardiographic study, determined the concentration of natriuretic peptides (NUP): N-terminal fragment of the precursor of cerebral NUP (NT-proBNP) and mid-regional pro-atrial NUP (MR-proANP). Results. In patients with CHF on the background of AF and COPD, a higher score of the severity of clinical symptoms was established in comparison with the 3rd group (p<0,001). The features of heart remodeling in patients of the main group were revealed in comparison with patients with CHF and AF without COPD: lower volume indices of the left (p=0,001) and right (p=0,004) atria and values of the indexed index of the end-diastolic area of the right ventricle (RV) (p=0,007), lower contractility of the RV, the presence of RV hypertrophy. The effect of AF on the structural and functional parameters of the heart in patients with CHF, COPD and AF can be judged by comparison with patients with CHF and COPD without AF: higher values of the size of the RV (p=0,012), indexed index of the end-systolic area of the RV (p<0,001), lower systolic function of the RV on the background of higher pressure in the RV cavity (p=0,001). Defined the highest level of NT-proBNP in patients with CHF, AF and COPD in comparison with its level in patients of the 2nd group (p<0,001) and in patients 3rd groups (p=0,010). Higher levels of MR-proANP were found in patients with CHF and AF without COPD (p<0,001). Conclusion. In patients with CHF, AF and COPD, more pronounced clinical symptoms are caused by chronic bronchial obstruction. Pathogenetic features of left and right heart remodeling in patients with CHF on the background of AF and COPD were revealed. For the early detection of HF in patients with AF the greatest diagnostic importance is the determination of the level of MR-proANP, however, in patients with combined AF and COPD the most informative is the determination of the concentration of NT-proBNP.

scholarly journals Comparative analysis of the diagnostic significance of heart failure markers in comorbid patients with atrial fibrillation and chronic obstructive pulmonary disease

2019 ◽  
Vol 10 (1) ◽  
pp. 20-27 ◽  
Author(s):  
Tatiana A. Dzyurich ◽  
Anna I. Chesnikova ◽  
Vladimir P. Terentyev ◽  
Olga E. Kolomatskaya
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Chronic Obstructive Pulmonary Disease ◽  
Comparative Analysis ◽  
Chronic Heart Failure ◽  
Pulmonary Disease ◽  
Natriuretic Peptides ◽  
Chronic Obstructive ◽  
Diagnostic Significance ◽  
Obstructive Pulmonary Disease

Objective:to assess the diagnostic significance of atrial and brain natriuretic peptides for the detection of chronic heart failure in comorbid patients with atrial fibrillation and chronic obstructive pulmonary disease.Materials and methods:120 patients depending on the presence of chronic obstructive pulmonary disease (COPD), chronic heart failure (CHF) and atrial fibrillation (AF) were divided into the following groups: I group (n=28) — patients with COPD without cardiovascular disease (CVD), II group — patients with CHF and COPD without AF (n=30), III group — patients with CHF and AF without COPD (n=33), IV group — patients with CHF, AF and COPD (n=29). Th e concentration of precursors of brain and atrial natriuretic peptides (NUP) (NT-proBNP and MR-proANP) was evaluated.Results:The level of NT-proBNP exceeded the reference values in all patients with CHF (I, II, III groups). In patients with CHF, AF and COPD the highest values of NT-proBNP concentrations were obtained, which were 2.2 times higher in the group of patients with CHF and COPD without AF (p=0.000) and 1.9 times higher in patients with CHF and AF without COPD (p=0.01). Comparative analysis of the MR-proANP level allowed to judge a higher concentration of this indicator in patients with CHF and COPD without COPD in comparison with the level of the marker in the groups of patients with CHF, AF and COPD (p=0.001), CHF and COPD without AF (p=0.000) and COPD without CVD (p=0.000).Conclusions:in patients with AF and COPD, the study of brain NUP NT-proBNP in connection with structural and functional changes of the right ventricle, against the background of existing cardiac arrhythmias and pulmonary pathology is preferable to determine the presence and severity of CHF. The elevated level of MR-proANP is of diagnostic value in patients with AF and CHF without COPD, due to the increased volume load on the Atria due to the presence of AF.

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