Dyspnea in Chronic Low Ventricular Preload States

Tooba, Rubabin; Mayuga, Kenneth A.; Wilson, Robert; Tonelli, Adriano R.

doi:10.1513/annalsats.202005-581cme

Cited by 6 publications

(10 citation statements)

References 79 publications

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“…Importantly, low preload states can result in dyspnea, underscoring the importance of volume loading and recumbent exercise, as described in the tachycardia and exercise intolerance section. 212 Physical therapy that incorporates aerobic training and diaphragmatic breathing exercises can be a helpful adjunct to address underlying ventilatory abnormalities and muscle dysfunction, 196 , 213 as noted with other pulmonary diseases.…”

Section: Description Of Pathwaymentioning

confidence: 99%

2022 ACC Expert Consensus Decision Pathway on Cardiovascular Sequelae of COVID-19 in Adults: Myocarditis and Other Myocardial Involvement, Post-Acute Sequelae of SARS-CoV-2 Infection, and Return to Play

Gluckman¹,

Bhave²,

Allen³

et al. 2022

Journal of the American College of Cardiology

247

273

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Section: Description Of Pathwaymentioning

confidence: 99%

2022 ACC Expert Consensus Decision Pathway on Cardiovascular Sequelae of COVID-19 in Adults: Myocarditis and Other Myocardial Involvement, Post-Acute Sequelae of SARS-CoV-2 Infection, and Return to Play

Gluckman¹,

Bhave²,

Allen³

et al. 2022

Journal of the American College of Cardiology

247

273

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“…Dyspnea in low pre-load states with accompanying reduced cardiac output may contribute to symptoms among patients with autonomic dysfunction [ 39 ].…”

Section: Anatomy Of the Autonomic Nervous Systemmentioning

confidence: 99%

Autonomic dysfunction in SARS-COV-2 infection acute and long-term implications COVID-19 editor’s page series

Becker

2021

J Thromb Thrombolysis

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The autonomic nervous system (ANS) is a complex network of nerves originating in the brain, brain stem, spinal cord, heart and extracardiac organs that regulates neural and physiological responses to internal and external environments and conditions. A common observation among patients with the 2019 Coronavirus (CoV) (SARS-severe acute respiratory syndrome CoV-2) (SARS-CoV-2) or COVID-19 [ CO for corona, VI for virus, D for disease and 19 for when the outbreak was first identified (31 December 2019)] in the acute and chronic phases of the disease is tachycardia, labile blood pressure, muscular fatigue and shortness of breath. Because abnormalities in the ANS can contribute to each of these symptoms, herein a review of autonomic dysfunction in SARS-COV-2 infection is provided to guide diagnostic testing, patient care and research initiatives. Graphic abstract The autonomic nervous system is a complex network of nerves originating in the brain, brain stem, spinal cord, heart and extracardiac organs that regulates neural and physiological responses to internal and external environments and conditions. A common collection of signs and symptoms among patients with the 2019 Coronavirus (CoV) (SARS-severe acute respiratory syndrome CoV-2) (SARS-CoV-2) or COVID-19 [ CO for corona, VI for virus, D for disease and 19 for when the outbreak was first identified (31 December 2019)] is tachycardia, labile blood pressure, muscular fatigue and shortness of breath. Abnormalities in the autonomic nervous system (ANS) can contribute to each of these identifiers, potentially offering a unifying pathobiology for acute, subacute and the long-term sequelae of SARS-CoV-2 infection (PASC) and a target for intervention.

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“…In the current study, a low TFC value could be an indirect measure of reduced cardiac preload and/or hypovolemia as a cause of fatigue and dyspnoea. Low preload as a cause of dyspnoea was previously reported in patients with autonomic diseases and postural orthostatic [46,48,49].…”

Section: Discussionmentioning

confidence: 67%

Association of Cardiac Autonomic Responses with Clinical Outcomes of Myasthenia Gravis: Short-Term Analysis of the Heart-Rate and Blood Pressure Variability

Zawadka‐Kunikowska

Rzepiński²,

Tafil-Klawe

et al. 2022

JCM

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Introduction: The aim of the study was to assess cardiac and autonomic function in patients with myasthenia gravis (MG) and to explore its relationship with disease outcomes. Methods: Thirty-eight patients with an MG were enrolled (median age 40.5 years; median disease duration 5.5 years). Cardiovascular parameters, baroreflex sensitivity (BRS), spectral indices of short-term heart rate (HRV), and systolic blood pressure variability (SBPV) were compared with age- and gender-matched controls (n = 30). Cardiac autonomic function was assessed during the response to standing (tilt) and deep breathing tests (expiration/inspiration ratio-E/I). Results: HR and BP responses to the tilt test were similar in both groups. MG patients, as compared to controls, were characterized by altered SBPV at rest, significantly reduced HR response to the deep breathing test (p < 0.001), increased sympathovagal balance after tilt (delta LF/HF-RRI, p = 0.037), and lower values of BRS (p = 0.007) and hemodynamic parameters, i.e., cardiac index, index contractility, left ventricular work index, at rest and during tilt. There was no association between disease duration and autonomic parameters. Disease severity, as determined by MGFA (Myasthenia Gravis Foundation of America) corrected for age and sex, was an independent predictor of diminished vagal tone (E/I ratio) and increased sympathetic response to tilt (delta LF/HF-RRI) as measured with HRV. Lower BRS was associated with greater disease severity and older age. Hemodynamic parameters were predominantly predicted by age and sex. Conclusion: Our results confirm cardiac autonomic dysfunction among MG patients with predominant parasympathetic impairment. Clinicians should consider evaluation of autonomic balance in MG patients with, or at risk for, cardiovascular disease.

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Dyspnea in Chronic Low Ventricular Preload States

Cited by 6 publications

References 79 publications

2022 ACC Expert Consensus Decision Pathway on Cardiovascular Sequelae of COVID-19 in Adults: Myocarditis and Other Myocardial Involvement, Post-Acute Sequelae of SARS-CoV-2 Infection, and Return to Play

2022 ACC Expert Consensus Decision Pathway on Cardiovascular Sequelae of COVID-19 in Adults: Myocarditis and Other Myocardial Involvement, Post-Acute Sequelae of SARS-CoV-2 Infection, and Return to Play

Autonomic dysfunction in SARS-COV-2 infection acute and long-term implications COVID-19 editor’s page series

Association of Cardiac Autonomic Responses with Clinical Outcomes of Myasthenia Gravis: Short-Term Analysis of the Heart-Rate and Blood Pressure Variability

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