Relationship between exercise tolerance and TV vs. RR relationship in patients with heart disease.

BACKGROUND: Although patients with heart disease sometimes complain of shortness of breath with rapid and shallow ventilation, its precise characteristics are unclear. We evaluated the relationship between exercise tolerance and the degree of rapidness and shallowness of breathing during exercise. METHODS AND RESULTS: Thirty-eight heart disease patients with shortness of breath during daily activity underwent pulmonary function test and cardiopulmonary exercise testing on the same day. Regression line relating tidal volume to respiratory rate (TV/RR slope) during a ramp protocol below the inflection point was regarded as an indicator of rapid ventilation. Tidal volume after the inflection point was regarded as an indicator of shallow ventilation (TV at plateau). TV/RR slope showed weak but significant positive correlation with anaerobic threshold (r=0.317) and peak VO(2) (r=0.302). With VE vs. VCO(2) slope, it was negatively correlated (r=-0.528). TV at plateau was strongly correlated with inspiratory capacity (r=0.641). It also showed strong correlation with anaerobic threshold (r=0.594), peak VO(2) (r=0.550), and VE vs. VCO(2) slope (r=-0.390). There was positive correlation between TV/RR slope and TV at plateau (r=0.647). CONCLUSIONS: It is suggested that both rapid breathing and shallow breathing are related to impaired exercise tolerance. Shallow breathing is partly determined by the ability of chest expansion.

[A case of racemose hemangioma of a bronchial artery complicated with atrial septal defect and localized peripheral ground-glass opacity].

We report a case of racemose hemangioma of the right bronchial artery complicated with an atrial septal defect (ASD) and ground-glass opacity localized in the right upper lung lobe. A 42-year-old woman was admitted for the pre-operative assessment of ASD. Aortography and selective angiography revealed that the right bronchial artery was markedly dilated and convoluted, draining into the right intercostal arteries and the right upper pulmonary vein. The patient was suffering from exertional dyspnea, but produced no bloody sputum. Since videobronchoscopy showed normal mucosal findings without bronchiectasis, primary racemose hemangioma of the right bronchial artery was diagnosed, and was treated by ligation of the bronchial artery and patch-closure of the ASD. The ground-glass opacity observed preoperatively in the periphery of the right upper lung lobe vanished after surgery. This opacity was considered to have been localized pulmonary congestion due to augmented hydrostatic pressure in the right upper pulmonary vein, induced by increased pulmonary blood flow through the ASD and the drainage route of the racemose bronchial artery into right upper pulmonary vein.