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• W2108744534 abstract "Dyspnea is a cardinal symptom of heart failure. Both pulmonary venous distention and congestion may cause dyspnea in patients with left ventricular systolic failure. Data suggest that muscle weakness, in particular inspiratory muscle weakness, is common in patients with heart failure and may account, in part, for this symptom. We have shown that patients with diastolic dysfunction have diminished maximal subatmospheric static inspiratory muscle weakness; adopt a rapid, shallow breathing pattern during exercise; and experience dyspnea at low work loads when compared with matched control subjects.1Lavietes M.H. Gerula M.G. Fless K.G. Inspiratory muscle weakness in diastolic dysfunction.Chest. 2004; 126: 38-44Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar The study by Pedersen et al2Pedersen F. Raymond I. Mehlsen J. Atar D. Hildebrandt P.R. Prevalence of diastolic dysfunction as a possible cause of dyspnea in the elderly.Am J Med. 2005; 118: 25-31Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar and the accompanying editorial by Vedantham and Fleischmann3Vedantham V. Fleischmann K.E. Dyspnea and diastolic function weighing the evidence.Am J Med. 2005; 118: 32-34Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar do not discuss other mechanisms of dyspnea in the elderly. In addition, clinical and occult coronary artery disease (CAD) is common in the elderly,4Arora R.R. Mahar J. Goldman M.E. et al.Atrial kinetics and left ventricular diastolic filling in the healthy elderly.J Am Coll Cardiol. 1987; 11: 127-131Google Scholar, 5Phillips R.A. Goldman M.E. Andeljam M. Determinants if abnormal left ventricular filling in elderly hypertension.J Am Coll Cardiol. 1989; 14: 979-985Crossref PubMed Scopus (115) Google Scholar and although 2 patients were excluded from the cohort, the study does not exclude most patients with CAD, based on the low sensitivity of electrocardiographic exercise tests and lack of maximal exercise protocol. Vagaries in diastolic and systolic noninvasive parameters also may be predicted by cardiotonic medications, status of hypertension control, baseline blood pressure, and heart rate. In addition, age-related changes in diastolic dysfunction might be an epi-phenomemona of presbycardia rather than an association of other disease conditions.4Arora R.R. Mahar J. Goldman M.E. et al.Atrial kinetics and left ventricular diastolic filling in the healthy elderly.J Am Coll Cardiol. 1987; 11: 127-131Google Scholar These concerns, and the absence of age-matched control, weaken the conclusion of this otherwise meticulous study. The ReplyThe American Journal of MedicineVol. 118Issue 11PreviewWe thank Dr. Arora for his interest in our article.1 Dr. Arora commented that other mechanisms of dyspnea such as inspiratory muscle weakness were not discussed. The main purpose of our study was to assess the prevalence of diastolic dysfunction as a potential cause of dyspnea in a sample of elderly subjects. In this study we focused on the most common causes of dyspnea among heart and pulmonary diseases as well as obesity. Some of the subjects will undoubtedly have had other primary or contributory causes of dyspnea that were not revealed here, but because the causes of dyspnea are multiple, and not all examinations can be performed in all cases, a search for more rare causes of dyspnea has to be guided by the intuition of the physician, taking into account a combination of symptoms, signs and laboratory findings in each individual case. Full-Text PDF" @default.
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• W2108744534 title "Dyspnea in the elderly" @default.
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• W2108744534 doi "https://doi.org/10.1016/j.amjmed.2005.02.041" @default.
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