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Pulmonary Medicine
Volume 2012 (2012), Article ID 952741, 9 pages
http://dx.doi.org/10.1155/2012/952741
Review Article

Lungs in Heart Failure

1Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy
2Dipartimento di Medicina Clinica, Scienze Cardiovascolari ed Immunologiche, Università degli Studi di Napoli, 80131 Napoli, Italy
3Divisione di Cardiologia Riabilitativa, Fondazione Salvatore Maugeri, IRCCS, 20138 Milan, Italy
4Dipartimento di Scienze Cliniche e di Comunità, Università di Milano, 20138 Milan, Italy
5Division of Pulmonary and Critical Care and Medicine, Department of Medicine, University of Washington, Seattle, WA 98195-6420, USA

Received 2 July 2012; Revised 24 September 2012; Accepted 25 November 2012

Academic Editor: Bruce D. Johnson

Copyright © 2012 Anna Apostolo et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Lung function abnormalities both at rest and during exercise are frequently observed in patients with chronic heart failure, also in the absence of respiratory disease. Alterations of respiratory mechanics and of gas exchange capacity are strictly related to heart failure. Severe heart failure patients often show a restrictive respiratory pattern, secondary to heart enlargement and increased lung fluids, and impairment of alveolar-capillary gas diffusion, mainly due to an increased resistance to molecular diffusion across the alveolar capillary membrane. Reduced gas diffusion contributes to exercise intolerance and to a worse prognosis. Cardiopulmonary exercise test is considered the “gold standard” when studying the cardiovascular, pulmonary, and metabolic adaptations to exercise in cardiac patients. During exercise, hyperventilation and consequent reduction of ventilation efficiency are often observed in heart failure patients, resulting in an increased slope of ventilation/carbon dioxide (VE/VCO2) relationship. Ventilatory efficiency is as strong prognostic and an important stratification marker. This paper describes the pulmonary abnormalities at rest and during exercise in the patients with heart failure, highlighting the principal diagnostic tools for evaluation of lungs function, the possible pharmacological interventions, and the parameters that could be useful in prognostic assessment of heart failure patients.