A case of pulmonary hyperinflation in chronic heart failure: role of diuretic therapy and cardiorespiratory rehabilitation

Persistent dyspnoea during daily activities is commonly observed in patient with chronic heart failure (CHF) despite optimised pharmacological therapy. In CHF patients diuretics are essential for symptomatic treatment when fluid overloads with consequent pulmonary congestion or peripheral oedema. Appropriate use of diuretics is key element versus other drugs used for the success of the treatment of HF. Conversely, the inappropriate use of high doses of diuretics can cause adverse effects as electrolyte and fluid depletion, hypotension and hyperazotemia. Dyspnoea and fatigue, in patients with stable HF, are not related only to fluid overload and/or fluid retention but likely other mechanisms are linked to symptoms increase. These patients at the end of a rehabilitative treatment take less diuretic doses than during the period before the rehabilitative treatment, so reducing the principal adverse effects and improving the symptoms. In these patients in absence of venous congestion but in presence of an increase of symptoms augmenting diuretic drugs is not useful: it is very useful, instead, to undergo these patients a rehabilitative treatment because other mechanisms are linked to symptoms increase. In fact, in our report the predominant mechanism determining the increase in dyspnoea is likely related to an increase in physiological dead space.