Author + information
- Neil Brandon, MD∗ ()
- ↵∗South County Hospital Cardiology, 70 Kenyon Avenue, Suite 321, Wakefield, Rhode Island 02879
The article by Thibodeau et al. (1) characterizing the invasive hemodynamics of heart failure patients complaining of shortness of breath while bending corroborates a similar observation that I have recently published (2). Using Doppler echocardiography, I also demonstrated an increase in estimates of pulmonary capillary wedge pressure beyond baseline while bending forward, in normal patients as well as in those with known chronic heart failure (CHF). The present study adds to our knowledge of this phenomenon by examining a larger number of patients and measuring hemodynamics invasively.
Thibodeau et al. (1) did not emphasize what I have found over the years to be the clinical utility of recognizing this symptom. Shortness of breath bending, although nonspecific, is clinically helpful when it resolves with diuresis. Teaching and recognizing this symptom aids in the early clinical identification of patients with decompensated CHF, and can help prevent unnecessary hospitalizations.
Another unrecognized clinical symptom that I believe sometimes signals volume overload is a watery post-nasal drip, especially in the elderly. I propose that many patients labeled with “senile rhinitis” (3) have occult, chronic elevation in left ventricular filling pressures. The nasal discharge in these patients appears to be a symptom of right heart failure, similar to the appearance of isolated peripheral edema. I have seen many patients whose “post-nasal drip” resolves completely with diuresis and effective CHF treatment, including one recently whose severe, acute pulmonary edema was preceded only by 1 week of nasal drip, which never occurred previously and resolved completely after treatment. This is another nonspecific, but clinically useful, symptom for clinicians to be aware of and for researchers to study and characterize further.
- American College of Cardiology Foundation