The Breathless Heart - Apneas in Heart Failure (Bookzcity)

Further Details About This Book:

Heart failure is a major cause of hospitalization and mortality, despite recent
advancements in diagnosis and treatment. The search for hidden pathophysiological
triggers of disease evolution and potential targets of therapy has rediscovered an
old, forgotten feature of the heart failure syndrome: apnea. Apneas may present
themselves either as a sign or a symptom in the individual patient, but are often
overlooked by clinicians, though they are both a marker of severity and a mediator
of risk. Apneas are invariably associated with cyclic hyperpneas both in the asleep
and in the awake subject with heart failure, possibly as an initial compensatory
response.

Apnea/hyperpnea phenomena oblige the clinician to reevaluate the physiology of
respiration and cardiovascular function. However, is there still place for physiology
in the decision-making for patients with cardiovascular diseases in the era of imaging,
genetics, and molecular biology?

The answer is in the affi rmative, as demonstrated by the clinical value of periodic
breathing/Cheyne-Stokes respiration (PB/CSR) [1, 2] in patients with heart failure
(Fig. 1 ). This abnormal breathing pattern has been known for centuries, but it is only
during the last decades that its pathophysiology and its clinical meaning have been
adequately investigated.

In particular, the underlying derangement of neural control of respiratory centers,
its impact on prognosis, and the relevance of the phenomenon as a therapeutic
target have been the object of an increase of interest and literature during the last
decades, yet with diverse experimental fi ndings and contradictory opinions.
The recent failure of two large trials testing the effectiveness of noninvasive
mechanical ventilation (CANPAP and SERVE-HF) [3, 4] in improving the outcome
of heart failure patients has confi rmed the need to summarize the current knowledge
on this topic. For this purpose, this book has been thought for all researchers and
clinicians interested in the fi eld. An international faculty has collaborated in furnishing
a complete overview touching all aspects of the apnea phenomenon in heart
failure patients.