Medicine Institute.
Cardiac Electrophysiology, Heart and Vascular Institute.
Ann Am Thorac Soc. 2021 Apr;18(4):573-581. doi: 10.1513/AnnalsATS.202005-581CME.
Dyspnea in low-preload states is an underrecognized but growing diagnosis in patients with unexplained dyspnea. Patients can often experience debilitating symptoms at rest and with exertion, as low measured preload often leads to decreased cardiac output and ultimately dyspnea. In the present article, we performed a review of the literature and a multidisciplinary evaluation to understand the pathophysiology, diagnosis, and treatment of dyspnea in low-preload states. We explored selected etiologies and suggested an algorithm to approach unexplained dyspnea. The mainstay of diagnosis remains as invasive cardiopulmonary exercise testing. We concluded with a variety of nonpharmacological and pharmacological therapies, highlighting that a multifactorial approach may lead to the best results.
低前负荷状态下的呼吸困难是一种未被充分认识但日益增多的诊断，在不明原因呼吸困难的患者中。患者经常在休息和运动时出现使人虚弱的症状，因为低测量前负荷通常会导致心输出量减少，最终导致呼吸困难。在本文中，我们对文献进行了回顾，并进行了多学科评估，以了解低前负荷状态下呼吸困难的病理生理学、诊断和治疗。我们探讨了选定的病因，并提出了一种用于处理不明原因呼吸困难的算法。诊断的主要方法仍然是有创心肺运动试验。我们总结了各种非药物和药物治疗方法，强调多因素方法可能会带来最好的结果。
