The Experts below are selected from a list of 213 Experts worldwide ranked by ideXlab platform

Matthew T. Naughton - One of the best experts on this subject based on the ideXlab platform.

  • Epidemiology of central sleep apnoea in heart failure
    International Journal of Cardiology, 2016
    Co-Authors: Matthew T. Naughton
    Abstract:

    Central sleep apnoea occurs in about a third of patients with reduced systolic heart failure and is a marker of increased mortality. Such patients usually are older males with advanced heart failure (i.e., high pulmonary wedge pressure), often in atrial fibrillation, with evidence of hyperventilation (i.e., low PaCO2) in the absence of hypoxemia. Characteristically, ventilation waxes and wanes in a sinusoidal pattern, with mild hypoxemia, occurring in the lighter levels of sleep usually when supine. Snoring may also occur in central sleep apnoea, often at the peak of hyperventilation, sometimes contributing to the confusion or overlap with obstructive sleep apnoea. Central sleep apnoea is associated with orthopnoea, Paroxysmal Nocturnal Dyspnoea and an oscillatory respiratory pattern with an incremental cardiopulmonary exercise study. Importantly, heart failure therapies (e.g., afterload reduction, diuresis, pacemakers, transplantation) attenuate central sleep apnoea. Night to night variability in severity of central sleep apnoea may occur with changes in patients' posture during sleep (less severe when sleeping on-side or upright).

  • Cheyne–Stokes respiration: friend or foe?
    Thorax, 2012
    Co-Authors: Matthew T. Naughton
    Abstract:

    Background Orthopnoea and Paroxysmal Nocturnal Dyspnoea are common entities regularly confronting thoracic physicians, particularly those with an interest in sleep medicine or non-invasive ventilatory support. One major cause is heart failure (HF), usually associated with abnormal lung function tests, and either obstructive or central sleep apnoea with Cheyne–Stokes respiration (CSA–CSR). Whereas obstructive apnoea is considered injurious to the cardiovascular system, the effects of CSA–CSR are less clear and may be a compensatory response to severe HF. Aim To determine whether there are compensatory or possibly beneficial aspects caused by CSA–CSR in HF. Methods Literature review. Results CSA–CSR can be detrimental in terms of intermittent hypoxaemia, arousals and autonomic dysregulation. However, it is also associated with the beneficial effects of hyperventilation-related increases in end-expiratory lung volume, intrinsic positive airway pressure, assistance to stroke volume, attenuation of excessive sympathetic nervous activity, avoidance of hypercapnic acidosis and finally the provision of periodic rest to fatigue-prone respiratory pump muscles. Conclusions CSA–CSR has physiological features more likely to be compensatory and beneficial than injurious in HF. Some aspects of CSA–CSR are similar to those seen with positive airway pressure.

  • Assessment and management of the patient presenting with snoring.
    Australian Family Physician, 2002
    Co-Authors: Matthew T. Naughton
    Abstract:

    BACKGROUND: Snoring is experienced regularly by approximately 30% of male adults, of whom one in seven will have obstructive sleep apnoea syndrome. Women experience snoring and apnoea at a rate of approximately half of that of men. OBJECTIVE: General practitioners have a key role in the management of snoring. Patients whose symptoms of excessive sleepiness and loud habitual snoring more than three times per week, should alert the GP to the presence of apnoeas. DISCUSSION: The co-existence of systemic essential hypertension, especially if more than two drugs are required for its control, or any other cardiovascular disease, would increase suspicion of significant sleep apnoea. Conservative measures such as reduction in weight, alcohol and nasal resistance can be instigated in such patients immediately. Patients who have failed conservative treatment, or have suspected moderate to severe apnoea, need to be referred to a physician trained in sleep disorders for further evaluation and management. Snoring represents a trumpeters introduction to the three spectra of sleep related breathing disorders. These vary from simple snoring to profoundly severe snoring associated with obstructive sleep apnoea syndrome and cardiovascular sequelae, through to orthopnoea, Paroxysmal Nocturnal Dyspnoea and fragmented sleep associated with unstable or decompensated cardiovascular and/or pulmonary disease. (author abstract)

  • Pathophysiology and treatment of Cheyne-Stokes respiration
    Thorax, 1998
    Co-Authors: Matthew T. Naughton
    Abstract:

    Cheyne-Stokes respiration is a disorder characterised by recurrent central apnoeas during sleep alternating with a crescendo-decrescendo pattern of tidal volume.1 2 It is often observed in patients with congestive heart failure, usually during stages 1 and 2 non-REM sleep when ventilation is under chemical-metabolic control.2 Patients with Cheyne-Stokes respiration usually present with the symptoms of orthopnoea, Paroxysmal Nocturnal Dyspnoea, excessive daytime sleepiness and witnessed apnoeas in the setting of congestive heart failure.1 3 Excessive weight and snoring may be absent. Approximately 50% of patients with symptomatic congestive heart failure have sleep apnoea, mainly of the Cheyne-Stokes respiration variety.4-6 As congestive heart failure occurs in 1% of the adult population and doubles in prevalence for each decade beyond 60 years,7 Cheyne-Stokes respiration is common but often left unrecognised. Based upon small case series, patients with congestive heart failure and Cheyne-Stokes respiration have a significantly greater mortality,8 9 particularly if present during wakefulness,10 than those without Cheyne-Stokes respiration. Although Cheyne-Stokes respiration is likely to arise as a result of congestive heart failure, once present it is likely to have adverse effects upon cardiac function akin to a vicious cycle. Following an initial cardiac insult there is a compensatory increase in sympathetic activity11 12 which in susceptible patients causes hyperventilation,13 destabilises respiratory control, and leads to Cheyne-Stokes respiration. Once Cheyne-Stokes respiration is established, apnoea related hypoxaemia causes cardiac diastolic dysfunction.14 Hypoxaemia and arousals lead to further increases in sympathetic activity15 which contribute to potentially fatal arrhythmias16-18 and further cardiotoxicity.19 Hyperventilation and resultant increased work of the respiratory muscles probably play a part in the symptom of Paroxysmal Nocturnal Dyspnoea1 and place an increased demand upon the already reduced cardiac output.20 Finally, patients with congestive heart failure and Cheyne-Stokes …

Oomen K George - One of the best experts on this subject based on the ideXlab platform.

  • fourteen year old boy with decreased appetite and pedal swelling
    Heart, 2018
    Co-Authors: Gopal Chandra Ghosh, Sreekumar Aparna, Oomen K George
    Abstract:

    Clinical introduction A 14-year-old boy presented with history of decreased appetite and bilateral swelling of feet for 6 months. He did not give any associated history of orthopnoea or Paroxysmal Nocturnal Dyspnoea. He was born by a normal delivery after a non-consanguineous marriage. He had an unremarkable birth and childhood health history. There was no family history of significant cardiovascular illness or sudden death. Clinical examination showed an average built boy with elevated jugular venous pressure with prominent v wave and bilateral pitting pedal oedema. Cardiovascular examination showed normal first (S1) and second (S2) heart sounds and a short early systolic murmur over tricuspid region. Other systems examination was remarkable for soft tender hepatomegaly. ECG showed sinus rhythm with tall, peaked p waves. Chest X-ray revealed enlargement along the right cardiac border. Transthoracic echocardiographic images are shown in figure 1A (apical four-chamber view) and figure 1B (tricuspid inflow Doppler). There was no colour Doppler evidence of interatrial shunt. Question What is the most likely diagnosis of his condition? Endomyocardial fibrosis (EMF) Ebstein’s anomaly Arrhythmogenic right ventricular dysplasia (ARVD) Idiopathic dilatation of right atrium Restrictive cardiomyopathy

Ayushi Mehta - One of the best experts on this subject based on the ideXlab platform.

  • Unruptured giant left ventricular pseudoaneurysm after silent myocardial infarction
    Case Reports, 2018
    Co-Authors: Rajeev Bhardwaj, Sachin Sondhi, Ayushi Mehta
    Abstract:

    An 88-year-old woman presented with complaints of class 2 Dyspnoea for the last 6 months with episodes of Paroxysmal Nocturnal Dyspnoea. Except for her age, she had no other risk factor for coronary artery disease. On cardiovascular examination, she had double apical impulse with a pan-systolic murmur at the apex and her ECG showed Q waves in inferior leads. She had one episode of resting typical chest pain 2 years back for which she did not seek medical consultation; afterwards, she never experienced angina pain. Transthoracic echocardiography revealed giant aneurysm involving the lateral wall of the left ventricle (figure 1, videos 1 and 2). The ratio of the maximum diameter of the orifice to the maximum internal dimensions of the aneurysmal cavity was less than 0.5 (figure 2). There was large clot in the aneurysm involving the posterior wall of the left ventricle (figures 3 and video 2). The colour flow signals across the neck of aneurysm showed bidirectional flow (figure 4) and moderate mitral …

Keitaro Nakamoto - One of the best experts on this subject based on the ideXlab platform.

  • Phantom tumour of the lung
    Case Reports, 2013
    Co-Authors: Takeshi Saraya, Kosuke Ohkuma, Aya Hirata, Keitaro Nakamoto
    Abstract:

    A 74-year-old previously healthy man was referred to our hospital due to Dyspnoea on effort lasting for 2 months and Paroxysmal Nocturnal Dyspnoea over the previous month. He had no remarkable medical history and was an ex-smoker (45 pack-years). Vital signs were normal with a heart rate of 80 bpm, respiratory rate 18 breaths/min, body temperature 36.3°C and oxygen saturation 97% measured at ambient air, but only mild elevation of blood pressure (148/80 mm Hg) was noted. Physical examination showed decreased first heart sound, but jugular venous dilation or oedema was …

Pankaj Malhotra - One of the best experts on this subject based on the ideXlab platform.

  • Phantom tumour and heart failure.
    Case Reports, 2018
    Co-Authors: Rajeev Sandal, Aditya Jandial, Kundan Mishra, Pankaj Malhotra
    Abstract:

    A 66-year-old man presented with progressive breathlessness for 1 week. Further history was consistent with orthopnoea and Paroxysmal Nocturnal Dyspnoea. He was a known case of ischaemic heart disease, on medical management with poor compliance, for 5 years. On examination, blood pressure was 130/70 mm Hg, pulse rate 94 beats/min and respiratory rate 36 breaths/min with SpO2 92% at room air. He had raised jugular venous pressure (12 cm of water), bilateral pitting pedal oedema and bilateral basal crepitation on chest auscultation with gallop rhythm (LVS3). Echocardiography revealed systolic …