title: Anterior crackles: a neglected sign?
abstract: We report on a man, aged 83 years, with chronic heart failure, atrial fibrillation, right ventricular pacing, and worsening exertional dyspnea who was referred for cardiac resynchronization therapy. Detection by anterior chest auscultation of pulmonary crackles during comfortable supine breathing in the context of documented low filling pressures led to the realization that unrecognized pulmonary fibrosis, not congestion, was the principal cause of his shortness of breath. We propose that the incidental finding in chronic heart failure of diffuse anterior crackles during comfortable supine breathing initiate a workup for alternate disorders such as occult pulmonary fibrosis.
authors: University Health Network and Mount Sinai Hospital, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors: Maneesh
authors: M
authors: Sud
authors: Alan
authors: A
authors: Barolet
authors: Michael
authors: M
authors: McDonald
authors: John S
authors: JS
authors: Floras
mesh_terms: D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications; D001314:Auscultation; D058406:Cardiac Resynchronization Therapy; D002908:Chronic Disease; D004417:Dyspnea / Q000175:diagnosis* / Q000628:therapy; D006333:Heart Failure / Q000150:complications; D006801:Humans; D008297:Male; D011658:Pulmonary Fibrosis / Q000175:diagnosis* / Q000000981:diagnostic imaging; D012017:Referral and Consultation; D012135:Respiratory Sounds / Q000175:diagnosis*; D016683:Supine Position; D014057:Tomography, X-Ray Computed; D018497:Ventricular Dysfunction, Right / Q000209:etiology / Q000628:therapy