ABSTRACT
Abstract Heart failure (HF) is the most common cause of pulmonary hypertension (PH), and reduced exercise capacity and exertional dyspnea are the most frequent concerns in patients with PH-HF. Indeed, carbon dioxide end-tidal partial pressure (PETCO 2 ) during exercise is a well-established noninvasive marker of ventilation/perfusion ratio in PH. We aimed to evaluate the effect of aerobic exercise training on PETCO 2 response during exercise in a 59-year-old woman with PH secondary to idiopathic dilated cardiomyopathy. The patient with chronic fatigue and dyspnea at mild-to-moderate efforts was admitted to a cardiorespiratory rehabilitation program and had her cardiorespiratory response to exercise assessed during a cardiopulmonary exercise testing performed before and after three months of a thrice-weekly aerobic exercise training program. Improvements in aerobic capacity (23.9%) and endurance time (37.5%) and reduction in ventilatory inefficiency (-20.2%) was found after intervention. Post-intervention improvements in PETCO 2 at ventilatory anaerobic threshold (23.3%) and change in PETCO 2 kinetics pattern, with progressive increases from rest to peak of exercise, were also found. Patient also improved breathing pattern and timing of ventilation. This case report demonstrated for the first time that aerobic exercise training might be able to improve PETCO 2 response during exercise in a patient with PH-HF.
Subject(s)
Humans , Male , Female , Middle Aged , Cardiomyopathy, Dilated/rehabilitation , Endurance Training , Hypertension, Pulmonary/rehabilitation , High-Frequency Ventilation , Cardiomyopathy, Dilated/prevention & control , Pulmonary Gas Exchange , Exercise Test , Cardiac Rehabilitation/methods , Hypertension, Pulmonary/prevention & controlABSTRACT
Cardiopulmonary rehabilitation is a promising therapy for Pulmonary arterial hypertension (PAH) whose survival does not exceed 65% at five years. We performed a literature search about rehabilitation on PAH in MEDLINE, LILACS and COCHRANE databases, considering articles from 2005 to 2017. Fifteen articles were incorporated in the final analysis. We obtained information about safety parameters, type of exercises applied, duration and frequency of sessions. The interventions included aerobic, resistance and respiratory muscle training exercises. The results showed improvements in peak oxygen uptake, six minutes walking test, quality of life and inspiratory muscle strength, among others. We conclude that the evidence supports the recommendation of physical rehabilitation in selected patients with stable PAH as a complementary strategy to the available pharmacological therapy.
Subject(s)
Humans , Exercise Therapy/methods , Cardiac Rehabilitation/methods , Hypertension, Pulmonary/rehabilitation , Quality of LifeABSTRACT
La Hipertensión Pulmonar (HTP) es un desorden progresivo caracterizado por el incremento de la presión en arterias pulmonares¹. Se caracteriza por cambios en la mayoría de las arterias pulmonares distales, lo que provoca un aumento de la resistencia vascular pulmonar, aumenta la presión y restringe el flujo de sangre a través de la circulación pulmonar2-3. El aumento de presión de la arteria pulmonar produce una sobrecarga ventricular derecha, con hipertrofia y dilatación ventricular². La HTP produce manifestaciones como disnea, mareo, edema de extremidades inferiores y dolor torácico, lo que interfiere mucho en la realización de actividades de la vida diaria y deterioro de la calidad de vida¹. El ejercicio no se ha utilizado como terapia habitual en HTP debido a la percepción del riesgo de muerte súbita cardíaca y la posibilidad teórica de que el ejercicio podría conducir a un empeoramiento de la hemodinámica vascular pulmonar y deterioro de la función cardíaca derecha. Algunos estudios sobre la práctica de ejercicio supervisado4 y en domicilio5 indican que es más segura la realización de manera supervisada y monitorizada por el alto riesgo de eventos adversos graves en estos pacientes. En esta revisión se analiza la evidencia acerca de los beneficios del ejercicio en mejorar la distancia recorrida en el Test de Marcha de 6 minutos, el incremento del consumo de oxígeno y la mejoría de la calidad de vida en pacientes con HTP.
Pulmonary Artery Hypertension (PAH) is a progressive disorder characterized by an increased pressure in the main pulmonary arteries related to changes in the distal pulmonary arterial vasculature leading to an increased pulmonary vascular resistance1-3. A pressure overload of the right ventricle, dilation and hypertrophy follow.1-3. Fainting, leg edema and chest pain greatly interfere with daily activities and quality of life. Exercise has not routinely been used in these patients for concerns about a deterioration of pulmonary artery hemodynamics and right ventricular function. In some studies exercise has been reported to be safer in a supervised situation at home. Herein, we analyzed available evidence of the benefits of exercise through the increase in distance during de 6 min walk test, increment in oxygen consumption and improvement in quality of life in patients with PAH.
Subject(s)
Humans , Exercise , Walking/physiology , Walk Test , Hypertension, Pulmonary/rehabilitation , Quality of LifeABSTRACT
Antecedentes. Riociguat es un miembro de una nueva clasede compuestos (estimuladores de la guanilatociclasa solubles), se ha demostrado en estudios clínicos previos el beneficio en el tratamiento dela hipertensión pulmonar tromboembólica crónica. Métodos. En esta fase 3, multicéntrico, aleatorizado, doble-ciego, controlado con placebo,se asignó aleatoriamente a 261 pacientes con inoperable hipertensión pulmonar tromboembólica crónica o la hipertensión pulmonar persistente o recurrente realizada una endarterectomía pulmonar para recibir placebo o riociguat. El punto final primario fueel cambio desde el inicio hasta el final de la semana16 en la distancia caminada en 6 minutos. Los puntos finales secundarios incluyeron cambios des de el inicio de la resistencia vascular pulmonar, Nivel N-terminal pro-péptido natriurético cerebral(NT-proBNP), la organización mundial de la salud(OMS) clase funcional, nos demuestra el tiempo hasta el empeoramiento clínico, en la escala de Borg de la disnea, tomando las variables de calidad de vida y la seguridad...
Subject(s)
Hypertension, Pulmonary/prevention & control , Hypertension, Pulmonary/rehabilitationABSTRACT
Antecedentes Riociguat es un estimulador de la guanilatociclasa soluble, el cual se ha demostrado en unensayo de fase 2 el beneficio en el tratamiento dela hipertensión arterial pulmonar...
Subject(s)
Hypertension, Pulmonary/prevention & control , Hypertension, Pulmonary/rehabilitationABSTRACT
O teste de caminhada de 6 minutos (T6) é utilizado na avaliação de doenças cardiopulmonares por sua capacidade prognóstica, facilidade de realização e reprodutibilidade. A hipertensão pulmonar (HP) é definida e classificada como uma consequência hemodinâmica que leva ao aumento da pressão arterial pulmonar, podendo resultar em uma falência ventricular direita e com consequente morte. Este relato de caso retrata a indicação do T6 pela equipe de cardiologia de um hospital universitário como forma de controle funcional de um paciente com HP, pós-introdução e início da terapêutica.
The 6-minute walk test (T6) is used to assess cardiopulmonary diseases due to its prognosis capacity, easy performance and reproducibility. Pulmonary hypertension (PH) is defined and classified as a hemodynamic consequence leading to increased pulmonary arterial pressure and may result in right ventricular failure and consequent death. This case reports the prescription of T6 by the cardiology team at a university hospital as a means of physical control of a patient with HP, after the introduction and initiation of therapy.