title: Exertional dyspnoea in chronic heart failure: the role of the lung and respiratory mechanical factors.
abstract: Exertional dyspnoea is among the dominant symptoms in patients with chronic heart failure and progresses relentlessly as the disease advances, leading to reduced ability to function and engage in activities of daily living. Effective management of this disabling symptom awaits a better understanding of its underlying physiology.Cardiovascular factors are believed to play a major role in dyspnoea in heart failure patients. However, despite pharmacological interventions, such as vasodilators or inotropes that improve central haemodynamics, patients with heart failure still complain of exertional dyspnoea. Clearly, dyspnoea is not determined by cardiac factors alone, but likely depends on complex, integrated cardio-pulmonary interactions.A growing body of evidence suggests that excessively increased ventilatory demand and abnormal "restrictive" constraints on tidal volume expansion with development of critical mechanical limitation of ventilation, contribute to exertional dyspnoea in heart failure. This article will offer new insights into the pathophysiological mechanisms of exertional dyspnoea in patients with chronic heart failure by exploring the potential role of the various constituents of the physiological response to exercise and particularly the role of abnormal ventilatory and respiratory mechanics responses to exercise in the perception of dyspnoea in patients with heart failure.
authors: Dépt de Médecine, Service de Pneumologie, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada.
authors: Bruno-Pierre
authors: BP
authors: Dubé
authors: Centro Cardiologico Monzino, IRCCS, Milan, Italy Dept of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy.
authors: Piergiuseppe
authors: P
authors: Agostoni
authors: Sorbonne Universités, UPMC Université Paris 06, INSERM, UMRS 1158 Neurophysiologie respiratoire expérimentale et clinique, Paris, France Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service des Explorations Fonctionnelles de la Respiration, de l'Exercice et de la Dyspnée (Département "R3S", Pôle PRAGUES), Paris, France pierantonio.laveneziana@psl.aphp.fr.
authors: Pierantonio
authors: P
authors: Laveneziana
mesh_terms: D002908:Chronic Disease; D018450:Disease Progression; D004417:Dyspnea / Q000209:etiology* / Q000503:physiopathology; D015444:Exercise; D017079:Exercise Tolerance; D006333:Heart Failure / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D006439:Hemodynamics; D006801:Humans; D008168:Lung / Q000503:physiopathology*; D011379:Prognosis; D015656:Respiratory Mechanics; D012307:Risk Factors