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ORTHOPNEA: ITS RELATION TO THE INCREASED VENOUS PRESSURE OF MYOCARDIAL FAILURE

ORTHOPNEA: ITS RELATION TO THE INCREASED VENOUS PRESSURE OF MYOCARDIAL FAILURE Abstract The factors that impel patients with myocardial failure of the congestive type to sit up in bed in order to breathe more comfortably have aroused the curiosity of many investigators. Numerous theories of the pathogenesis of orthopnea have been advanced, but none completely accounts for all the characteristics of the phenomenon. REVIEW OF THE LITERATURE The earlier writers generally believed that the sitting posture was assumed because the accessory muscles of inspiration could then be used to greater advantage. Hofbauer,1 however, showed that the chief respiratory difficulty in orthopneic patients was expiratory rather than inspiratory, and that the accessory muscles of expiration did not function more efficiently in the upright posture. According to him,2 the orthopneic position provides relief because it secures the following mechanical advantages: 1. The lower position of the diaphragm and the consequent increased capacity of the thorax increases the elastic tension of the lungs and so References 1. Hofbauer, L.: Ursachen der Orthopnoe , Ztschr. f. klin. Med. 61:389, 1907. 2. Hofbauer, L.: Ursachen der Orthopnoe: II. Die kardiale Orthopnoe , Ztschr. f. klin. Med. 79:128, 1914. 3. Aron, E.: Ueber einen Versuch den intrapleuralen Druck am lebenden Menschen zu messen , Virchows Arch. f. path. Anat. 126:517, 1891.Crossref 4. Bohr, C.: Die funktionellen Aenderungen in der Mittellage und Vitalkapazität der Lungen , Deutsche Arch. f. klin. Med. 88:385, 1907. 5. Rubow, V.: Die kardiale Dyspnoe , Ergebn. d. inn. Med. u. Kinderh. 3:71, 1909. 6. Christie, C. D., and Beams, A. J.: The Estimation of Normal Vital Capacity, with Especial Reference to the Effect of Posture , Arch. Int. Med. 30:34 ( (July) ) 1922.Crossref 7. Christie, C. D., and Beams, A. J.: Orthopnea , Arch. Int. Med. 31:85 ( (Jan.) ) 1923.Crossref 8. Haldane, J. S.; Meakins, J. C., and Priestley, J. G.: The Effects of Shallow Breathing , J. Physiol. 52:433, 1919. 9. Wilson, W. H.: The Influence of Posture on the Volume of the Reserve Air , J. Physiol. 64:54, 1928. 10. Sahli, H.: Lehrbuch der klinischen Untersuchungsmethoden , ed. 1, Leipzig, Franz Deuticke, 1894. 11. Hill, L.: The Influence of the Force of Gravity on the Circulation. J. Physiol. 18:15, 1895. 12. Field, H., Jr., and Bock, A. V.: Orthopnoea and the Effect of Posture upon the Rate of Blood Flow , J. Clin. Investigation 2:67, 1925.Crossref 13. Henderson, Y., and Haggard, H. W.: The Circulation and Its Measurement , Am. J. Physiol. 73:193, 1925. 14. Lawrence, J. S.; Hurxthal, L. M., and Bock, A. V.: Variations in Flow with Changes in Position in Normal and Pathologic Subjects , J. Clin. Investigation 3:613, 1927.Crossref 15. Rosen, I. T., and White, H. L.: The Relation of Pulse Pressure to Stroke Volume , Am. J. Physiol. 78: 168, 1926. 16. Turner, A. H.: Circulatory Minute Volumes of Healthy Young Women in Reclining, Sitting and Standing Positions , Am. J. Physiol. 80:601, 1927. 17. Henderson and Haggard (footnote 13, first reference). 18. Grollman, A.: The Effect of Variations in Posture on the Output of the Human Heart , Am. J. Physiol. 86:285, 1928. 19. Marshall, E. K., and Grollman, A.: A Method for the Determination of the Circulatory Minute Volume in Man , Am. J. Physiol. 86:117, 1928. 20. Bayliss, W. M., and Starling, E. H.: Observations on Venous Pressures and Their Relationship to Capillary Pressures , J. Physiol. 16:159, 1894. 21. Eyster, J. A. E., and Middleton, W. S.: Clinical Studies on Venous Pressure , Arch. Int. Med. 34:228 ( (Aug.) ) 1924.Crossref 22. Hill, L.: Physiology and Pathology of the Cerebral Circulation , London, J. & A. Churchill, 1896. 23. Weed, L. H., and Hughson, W.: Intracranial Venous Pressure and Cerebrospinal Fluid Pressure as Affected by Intravenous Injections of Solutions of Various Concentrations , Am. J. Physiol. 108:101, 1921. 24. Moritz, F., and Tabora, D.: Ueber eine Methode beim Menschen den Druck in oberflächlichen Venen exakt zu bestimmen , Deutsche Arch. f. klin. Med. 98:475, 1910. 25. Hooker, D. R.: Observations on the Venous Blood Pressure in Man , Am. J. Physiol. 35:73, 1914. 26. Eyster, J. A. E.: Venous Pressure and Its Clinical Applications , Physiol. Rev. 6:281, 1926. 27. Runge, H.: Ueber den Venandrucke im Schwangerschaft, Geburt und Wochenbett , Arch. f. Gynäk. 22:142, 1924.Crossref 28. West, H. F.: Clinical Studies on the Respiration: VI. A Comparison of Various Standards for the Normal Vital Capacity of the Lungs , Arch. Int. Med. 25:306 ( (March) ) 1920.Crossref 29. Wolff, H. G., and Blumgart, H. L.: The Cerebral Circulation: VI. The Effect of Normal and of Increased Intracranial Cerebrospinal Fluid Pressure on the Velocity of Intracranial Blood Flow , Arch. Neurol. & Psychiat. 21:795 ( (April) ) 1929. 30. Salathé, A.: Recherches sur le mecanisme de la circulation dans la cavite cephalo-rachidienne , Trav. du labor. de M. Marey 2:345, 1876. 31. Brissaud, E., and Franck, F.: Inscription des mouvements d'expansion et de rétrait du cerveau chez une femme présentant une vaste perte de substance du parietal gauche , Trav. du labor. de M. Marey 3:137, 1877. 32. Lundsgaard, C., and Van Slyke, D. D.: Cyanosis , Medicine 2:1, 1923. 33. Goldschmidt, S., and Light, A. B.: A Cyanosis, Unrelated to Oxygen Unsaturation, Produced by Increased Peripheral Venous Pressure , Am. J. Physiol. 73:173, 1925. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

ORTHOPNEA: ITS RELATION TO THE INCREASED VENOUS PRESSURE OF MYOCARDIAL FAILURE

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American Medical Association
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Copyright © 1930 American Medical Association. All Rights Reserved.
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0730-188X
DOI
10.1001/archinte.1930.00140100115011
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Abstract

Abstract The factors that impel patients with myocardial failure of the congestive type to sit up in bed in order to breathe more comfortably have aroused the curiosity of many investigators. Numerous theories of the pathogenesis of orthopnea have been advanced, but none completely accounts for all the characteristics of the phenomenon. REVIEW OF THE LITERATURE The earlier writers generally believed that the sitting posture was assumed because the accessory muscles of inspiration could then be used to greater advantage. Hofbauer,1 however, showed that the chief respiratory difficulty in orthopneic patients was expiratory rather than inspiratory, and that the accessory muscles of expiration did not function more efficiently in the upright posture. According to him,2 the orthopneic position provides relief because it secures the following mechanical advantages: 1. The lower position of the diaphragm and the consequent increased capacity of the thorax increases the elastic tension of the lungs and so References 1. Hofbauer, L.: Ursachen der Orthopnoe , Ztschr. f. klin. Med. 61:389, 1907. 2. Hofbauer, L.: Ursachen der Orthopnoe: II. Die kardiale Orthopnoe , Ztschr. f. klin. Med. 79:128, 1914. 3. Aron, E.: Ueber einen Versuch den intrapleuralen Druck am lebenden Menschen zu messen , Virchows Arch. f. path. Anat. 126:517, 1891.Crossref 4. Bohr, C.: Die funktionellen Aenderungen in der Mittellage und Vitalkapazität der Lungen , Deutsche Arch. f. klin. Med. 88:385, 1907. 5. Rubow, V.: Die kardiale Dyspnoe , Ergebn. d. inn. Med. u. Kinderh. 3:71, 1909. 6. Christie, C. D., and Beams, A. J.: The Estimation of Normal Vital Capacity, with Especial Reference to the Effect of Posture , Arch. Int. Med. 30:34 ( (July) ) 1922.Crossref 7. Christie, C. D., and Beams, A. J.: Orthopnea , Arch. Int. Med. 31:85 ( (Jan.) ) 1923.Crossref 8. Haldane, J. S.; Meakins, J. C., and Priestley, J. G.: The Effects of Shallow Breathing , J. Physiol. 52:433, 1919. 9. Wilson, W. H.: The Influence of Posture on the Volume of the Reserve Air , J. Physiol. 64:54, 1928. 10. Sahli, H.: Lehrbuch der klinischen Untersuchungsmethoden , ed. 1, Leipzig, Franz Deuticke, 1894. 11. Hill, L.: The Influence of the Force of Gravity on the Circulation. J. Physiol. 18:15, 1895. 12. Field, H., Jr., and Bock, A. V.: Orthopnoea and the Effect of Posture upon the Rate of Blood Flow , J. Clin. Investigation 2:67, 1925.Crossref 13. Henderson, Y., and Haggard, H. W.: The Circulation and Its Measurement , Am. J. Physiol. 73:193, 1925. 14. Lawrence, J. S.; Hurxthal, L. M., and Bock, A. V.: Variations in Flow with Changes in Position in Normal and Pathologic Subjects , J. Clin. Investigation 3:613, 1927.Crossref 15. Rosen, I. T., and White, H. L.: The Relation of Pulse Pressure to Stroke Volume , Am. J. Physiol. 78: 168, 1926. 16. Turner, A. H.: Circulatory Minute Volumes of Healthy Young Women in Reclining, Sitting and Standing Positions , Am. J. Physiol. 80:601, 1927. 17. Henderson and Haggard (footnote 13, first reference). 18. Grollman, A.: The Effect of Variations in Posture on the Output of the Human Heart , Am. J. Physiol. 86:285, 1928. 19. Marshall, E. K., and Grollman, A.: A Method for the Determination of the Circulatory Minute Volume in Man , Am. J. Physiol. 86:117, 1928. 20. Bayliss, W. M., and Starling, E. H.: Observations on Venous Pressures and Their Relationship to Capillary Pressures , J. Physiol. 16:159, 1894. 21. Eyster, J. A. E., and Middleton, W. S.: Clinical Studies on Venous Pressure , Arch. Int. Med. 34:228 ( (Aug.) ) 1924.Crossref 22. Hill, L.: Physiology and Pathology of the Cerebral Circulation , London, J. & A. Churchill, 1896. 23. Weed, L. H., and Hughson, W.: Intracranial Venous Pressure and Cerebrospinal Fluid Pressure as Affected by Intravenous Injections of Solutions of Various Concentrations , Am. J. Physiol. 108:101, 1921. 24. Moritz, F., and Tabora, D.: Ueber eine Methode beim Menschen den Druck in oberflächlichen Venen exakt zu bestimmen , Deutsche Arch. f. klin. Med. 98:475, 1910. 25. Hooker, D. R.: Observations on the Venous Blood Pressure in Man , Am. J. Physiol. 35:73, 1914. 26. Eyster, J. A. E.: Venous Pressure and Its Clinical Applications , Physiol. Rev. 6:281, 1926. 27. Runge, H.: Ueber den Venandrucke im Schwangerschaft, Geburt und Wochenbett , Arch. f. Gynäk. 22:142, 1924.Crossref 28. West, H. F.: Clinical Studies on the Respiration: VI. A Comparison of Various Standards for the Normal Vital Capacity of the Lungs , Arch. Int. Med. 25:306 ( (March) ) 1920.Crossref 29. Wolff, H. G., and Blumgart, H. L.: The Cerebral Circulation: VI. The Effect of Normal and of Increased Intracranial Cerebrospinal Fluid Pressure on the Velocity of Intracranial Blood Flow , Arch. Neurol. & Psychiat. 21:795 ( (April) ) 1929. 30. Salathé, A.: Recherches sur le mecanisme de la circulation dans la cavite cephalo-rachidienne , Trav. du labor. de M. Marey 2:345, 1876. 31. Brissaud, E., and Franck, F.: Inscription des mouvements d'expansion et de rétrait du cerveau chez une femme présentant une vaste perte de substance du parietal gauche , Trav. du labor. de M. Marey 3:137, 1877. 32. Lundsgaard, C., and Van Slyke, D. D.: Cyanosis , Medicine 2:1, 1923. 33. Goldschmidt, S., and Light, A. B.: A Cyanosis, Unrelated to Oxygen Unsaturation, Produced by Increased Peripheral Venous Pressure , Am. J. Physiol. 73:173, 1925.

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Apr 1, 1930

References