The mechanisms of breathlessness in heart failure as the basis of therapy

Johnson, Miriam J.; Clark, Andrew L.

doi:10.1097/spc.0000000000000181

Cited by 12 publications

(3 citation statements)

References 62 publications

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“…68 Chronic breathlessness in people with HF can be related to haemodynamic status, skeletal myopathy and sarcopenia, chronic or acute comorbidities. 16,69 In the case of breathlessness exacerbation, potentially reversible aggravating factors should be sought and if appropriate, specifically treated. After or parallel to optimizing the guidelines recommended treatment of HF (re-establishing and/or maintaining optimal volume status) 1,9,12,14 and/or concomitant disease, non-pharmacological and pharmacological symptomatic treatment should be pursued.…”

Section: Symptom Management 51 Breathlessnessmentioning

confidence: 99%

Palliative care for people living with heart failure: European Association for Palliative Care Task Force expert position statement

Sobański

Alt-Epping

Currow

et al. 2019

Cardiovascular Research

145

150

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Contrary to common perception, modern palliative care (PC) is applicable to all people with an incurable disease, not only cancer. PC is appropriate at every stage of disease progression, when PC needs emerge. These needs can be of physical, emotional, social, or spiritual nature. This document encourages the use of validated assessment tools to recognize such needs and ascertain efficacy of management. PC interventions should be provided alongside cardiologic management. Treating breathlessness is more effective, when cardiologic management is supported by PC interventions. Treating other symptoms like pain or depression requires predominantly PC interventions. Advance Care Planning aims to ensure that the future treatment and care the person receives is concordant with their personal values and goals, even after losing decision-making capacity. It should include also disease specific aspects, such as modification of implantable device activity at the end of life. The Whole Person Care concept describes the inseparability of the physical, emotional, and spiritual dimensions of the human being. Addressing psychological and spiritual needs, together with medical treatment, maintains personal integrity and promotes emotional healing. Most PC concerns can be addressed by the usual care team, supported by a PC specialist if needed. During dying, the persons’ needs may change dynamically and intensive PC is often required. Following the death of a person, bereavement services benefit loved ones. The authors conclude that the inclusion of PC within the regular clinical framework for people with heart failure results in a substantial improvement in quality of life as well as comfort and dignity whilst dying.

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Section: Symptom Management 51 Breathlessnessmentioning

confidence: 99%

Palliative care for people living with heart failure: European Association for Palliative Care Task Force expert position statement

Sobański

Alt-Epping

Currow

et al. 2019

Cardiovascular Research

145

150

View full text Add to dashboard Cite

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“…An extensive body of literature has provided understanding of the scope of pathophysiological mechanisms that can lead to breathlessness. The importance of lung mechanics, gas exchange, skeletal muscle, diaphragmatic and cardiac function [10,11 ▪ ,12] are well documented. However, it is increasingly clear that peripheral pathophysiology only tells us part of the story, and that brain mechanisms associated with affective state and expectations play an important role.…”

Section: Introductionmentioning

confidence: 99%

Breathlessness and the brain: the role of expectation

Marlow

Faull

Finnegan

et al. 2019

Current Opinion in Supportive &Amp; Palliative Care

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Purpose of review Breathlessness debilitates countless people with a wide range of common diseases. For some people, the experience of breathlessness is poorly explained by the findings of medical tests. This disparity complicates diagnostic and treatment options and means that disease-modifying treatments do not always have the expected effect upon symptoms. These observations suggest that brain processing of respiratory perceptions may be somewhat independent of disease processes. This may help to explain the dissonance observed in some patients between physical disease markers and the lived experience of breathlessness. Recent findings A body of breathlessness research using functional neuroimaging has identified a relatively consistent set of brain areas that are associated with breathlessness. These areas include the insula, cingulate and sensory cortices, the amygdala and the periaqueductal gray matter. We interpret these findings in the context of new theories of perception that emphasize the importance of distributed brain networks. Within this framework, these perceptual networks function by checking an internal model (a set of expectations) against peripheral sensory inputs, instead of the brain acting as a passive signal transducer. Furthermore, other factors beyond the physiology of breathlessness can influence the system. Summary A person's expectations and mood are major contributors to the function of the brain networks that generate perceptions of breathlessness. Breathlessness, therefore, arises from inferences made by the brain's integration of both expectations and sensory inputs. By better understanding individual differences across these contributing perceptual factors, we will be better poised to develop targeted and individualized treatments for breathlessness that could complement disease-modifying therapies.

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“…Встречается в клинической практике и обратная ситуация так называемого парадокса гемодинамики -манифестная ХСН у пациента с глобальной систолической и (или) диастоли-ческой дисфункцией левого желудочка умерен-ной выраженности [9,[19][20][21]. Наконец, наличие и выраженность некоторых имеющих высокую чувствительность симптомов и признаков ХСН, в частности утомляемости и снижения толерантно-сти к физической нагрузке, вообще невозможно объяснить исключительно дисфункцией миокар-да [22][23][24].…”

Section: Introductionunclassified

Pathology of the peripheral circulation in chronic heart failure

et al. 2017

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, Соловцов М.А. 4, Чернявская Г.М. Россия, 634012, г. Томск, ул. Киевская, 111а 2 Сибирский государственный медицинский университет (СибГМУ) Россия, 634050, г. Томск, Московский тракт, 2 3 Сургутский государственный университет (СурГУ) Россия, 628412, г. Сургут, пр. Ленина, 1 4 Томская областная клиническая больница (ТОКБ) Россия, 634063, г. Томск, ул. И. Черных, 96 РЕЗЮМЕ В механизмах развития хронической сердечной недостаточности (ХСН) ключевая роль традиционно отводится нарушению внутрисердечной гемоциркуляции. Так, в рекомендациях по оценке и лечению ХСН у взрослых эксперты Американской коллегии кардиологов и Американской ассоциации сердца (2001-2013 гг.) определяют ХСН как «сложный клинический синдром, который может быть вызван любым структурным или функциональным заболеванием сердца, нарушающим способность желудочка наполняться кровью или изгонять ее». Обычно справедливо полагают, что чем выраженнее инотроп-ная и (или) люситропная несостоятельность соответствующего желудочка у пациента с ХСН, тем в целом ниже у него качество жизни и хуже прогноз. Вместе с тем степень выраженности клинических проявлений ХСН, с одной стороны, и снижение уровня удовлетворенности жизнью -с другой, далеко не всегда зависят только от состояния внутрисердечной гемодинамики. Авторы обзора анализируют работы, опубликованные по проблеме патологии периферического кровообращения при ХСН. После-довательно рассматривается роль ремоделирования периферических сосудов и увеличения жесткости артерий, дисфункции эндотелия крупных и резистивных артерий, а также патологии микроциркуляции. 2 НИИ кардиологии, Томский национальный исследовательский медицинский центр (ТНИМЦ) Российской академии наук (РАН)Показано, что развитие и прогрессирование ХСН сопровождается ухудшением периферического крово-обращения за счет ремоделирования артерий мышечно-эластического типа и вен со снижением сосуди-стого дилатационного резерва, повышения как регионального сосудистого сопротивления, так и веноз-ного тонуса, нарушения тканевого транскапиллярного обмена кислорода и активации прокоагулянтных свойств крови. Обсуждается значение вазоконстрикторных эффектов нейрогуморальных систем и вос-паления в механизмах нарушения периферического кровообращения у пациентов с ХСН, особенно ассоциированной с метаболическим синдромом.Ключевые слова: хроническая сердечная недостаточность, периферическое кровообращение, ремо-делирование сосудов, дисфункция эндотелия, воспаление, гиперкоагуляция, патология микроцир-куляции.

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The mechanisms of breathlessness in heart failure as the basis of therapy

Abstract: Previous work in relation to the role of skeletal muscle and sympathetic nervous system has set the scene for targeted therapies for the relief of breathlessness in people with heart failure.

Cited by 12 publications

References 62 publications

Palliative care for people living with heart failure: European Association for Palliative Care Task Force expert position statement

Palliative care for people living with heart failure: European Association for Palliative Care Task Force expert position statement

Breathlessness and the brain: the role of expectation

Pathology of the peripheral circulation in chronic heart failure

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