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Improvement
of the Cardiac Function by Nasal Bilevel Positive Airway Pressure in a
67-year-old Woman with Myotonic Dystrophy
Yasunori Kakuta,
MD1; Schinichi Okabe, MD2; Jun Demachi, MD2;
Kunio Shirato, MD2; Wataru Hida, MD2. Nishitaga National
Hospital1 and Tohoku University School of Medicine2, Sendai,
Japan.
Introduction: In myotonic
dystrophy (DM) nocturnal hypoventilation due to diaphragmatic weakness causes
severe desaturation. The effect on the cardiac function of this chronic respiratory
failure, however, has not received much attention, because the abnormality of
the cardiac function evaluated by echocardiography is minor. Here, we report
a case of DM, which showed that the nocturnal desaturation was harmful to the
function of the cardiac muscle and that ventilation support overcame this problem.
Case summary: A 67-year-old
woman with DM received nasal bilevel positive airway pressure (BiPAP) during
the night to treat her chronic respiratory failure. The clinical course before
and after treatment is summarized below.
| |
Before BiPAP |
0.5 Y after |
1 Y after |
| % of nocturnal SpO2<90% |
90 |
19 |
14 |
| Diurnal PaO2 (Torr) |
45.3 |
53.3 |
58.5 |
| Diurnal PaCO2 (Torr) |
64.2 |
59.2 |
57.5 |
| Left ventricular ejection
fraction |
0.56 |
0.67 |
0.61 |
| Brain natriuretic peptide
(pg/ml) |
172 |
125 |
51 |
Discussion: As the plasma
brain natriuretic peptide level was raised before BiPAP, we can presume the
abnormality of cardiac function. It is likely due to the respiratory failure,
because BiPAP reduced it. The reason why we chose nasal BiPAP is that it is
less expensive and easier to apply to such patients of DM than volume controlled
noninvasive positive pressure ventilation.
Conclusion: Cardiac dysfunction
is present in DM with chronic respiratory failure even though the change of
cardiac function by echocardiography is slight, and ventilation support is useful
to improve this abnormality.
OF-01-124
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