The Importance of Diaphragmatic Function in Neuromuscular Expression in Patients With Chronic Heart Failure

Abstract

Chronic heart failure (CHF) is a set of symptoms and physical manifestations caused by the inability of the heart to perform its normal contractile function and satisfy the blood needs of all organs. This dysfunction leads to a non-physiological adaptation of all body systems, including the skeletal muscles and the diaphragm. The myopathy found in patients brings symptoms such as fatigue and intolerance to exercise, with an entity not always attributable to cardiac function. Neuromuscular incoordination is one of the symptoms related to CHF, causing an increased risk of mortality and hospitalization. The article reviews diaphragmatic adaptation in the presence of CHF and seeks to emphasize the importance of the diaphragm in understanding skeletal muscle incoordination in patients.

Symptoms Arising From the Diaphragm Muscle: Function and Dysfunction

“…Other symptoms are linked to the strong relationship between the diaphragm and the vagus nerve, stimulating the spinosolitary pathway (proprioception stimulated by diaphragmatic movement) and the parasympathetic response that follows [ 47 ]. An alteration of the correct parasympathetic responses creates neuromotor coordination disorders, emotional disorders (anxiety, depression, stress), and a lowering of pain tolerance [ 4 , 5 , 7 - 9 , 34 ].…”

“…It is fundamental for the function and circulation of the lymphatic system, the glymph, the cerebrospinal fluid, and the blood; it also plays a fundamental role in the perception of proprioception, pain, and emotional status [2][3][4][5][6][7]. The diaphragm is the postural muscle par excellence for maintaining balance, the stability of the lumbar area, and the expression of efficient neural coordination [8][9][10]. Breathing positively influences the cognitive aspect, stimulating synaptogenesis [10,11].…”

The Importance of the Diaphragm Muscle in Cardiac Rehabilitation after Myocardial Infarction

“…Let's consider that during a eupneic breath the diaphragm is involved for 70% compared to other respiratory accessory muscles; other skeletal muscles for motor actions are involved in a much smaller percentage, with loading and unloading cycles, such as 1% of the extensor digitorum longus muscle and 14% of the soleus muscle [36]. Furthermore, when we are standing and moving, a third of the diaphragm is removed from respiratory functions, as it is used for posture functions (intra-abdominal pressures) and to improve neuromotor function (parasympathetic stimulation) [43,44]. When the diaphragm is not functionally adequate, it can cause low back pain; this last symptom can be linked to the presence of coronary heart disease, even if the reasons are not fully clarified [45,46].…”