Cheyne-Stokes Respiration Revisited: Clinical Clue to the Diagnosis for Acute Exacerbation of Congestive Heart Failure.
A 72-year-old man was admitted to the hospital to initiate chemotherapy for pleomorphic lung
carcinoma (T4N0M1a, stage 4 cancer). He had a history of chronic systolic heart failure with
severe mitral regurgitation diagnosed five years prior to this admission who had been receiving
cardiac resynchronization therapy (CRT). He had complained of nocturnal dyspnea, especially
when lying flat, as well as of dyspnea on exertion. A few weeks prior to his admission, his dyspnea worsened to the point that he could not even walk a few steps, demonstrating a rapid deterioration of performance status.
On examination, he was in mild distress, with a performance status of 3 out of a possible score of 5, defined as capable of only limited self care; confined to bed or chair more than 50 percent of waking hours.1His vital signs were normal, except for his sinus tachycardia, with an elevated rate of 108 beats per minute. His oxygen saturation while breathing ambient air was above 90%. However, he was later noted to experience nocturnal desaturation as his oxygen saturation dropped to 80-85% at night while he was sleeping.
On the third day of the admission, he complained of increased shortness of breath at night. On examination, he was in respiratory distress and tachypnic. The body temperature was 37.3 °C, blood pressure of 94/70 mm Hg, pulse of 118 beats per minute, respiratory rate of 28 breaths per minute, and an oxygen saturation of 85% while he was breathing ambient air.
Pulm Res Respir Med Open J. 2016; SE(1): S12-S13. doi:10.17140/PRRMOJ-SE-1-104