2001 OPEN FORUM Abstracts
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 NationalHospital1 and Tohoku University School of Medicine2, Sendai,Japan.
Introduction: In myotonicdystrophy (DM) nocturnal hypoventilation due to diaphragmatic weakness causessevere desaturation. The effect on the cardiac function of this chronic respiratoryfailure, however, has not received much attention, because the abnormality ofthe cardiac function evaluated by echocardiography is minor. Here, we reporta case of DM, which showed that the nocturnal desaturation was harmful to thefunction of the cardiac muscle and that ventilation support overcame this problem.
Case summary: A 67-year-oldwoman with DM received nasal bilevel positive airway pressure (BiPAP) duringthe night to treat her chronic respiratory failure. The clinical course beforeand 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 ejectionfraction||0.56||0.67||0.61|
|Brain natriuretic peptide(pg/ml)||172||125||51|
Discussion: As the plasmabrain natriuretic peptide level was raised before BiPAP, we can presume theabnormality 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 isless expensive and easier to apply to such patients of DM than volume controllednoninvasive positive pressure ventilation.
Conclusion: Cardiac dysfunctionis present in DM with chronic respiratory failure even though the change ofcardiac function by echocardiography is slight, and ventilation support is usefulto improve this abnormality.