Benefits of a combined protocol of physical exercise and CPAP on a patient affected by heart failure and mitral insufficiency: a case report

Abstract

Objective: To describe the ideal/optimalapplication of continuous positive airway pressure (CPAP) and to evaluate its effect associated with physical exercise on functional capacity, respiratory muscle strength and quality of life in a patient with heart failure (HF) and moderate Mitral Insufficiency (MI). Methods: A 60 year old female patient, left ventricular ejection fraction (LVEF) of 33%, functional class III (NYHA), with respiratory muscle weakness (<70% predicted). Main complaints: calf pain and dyspnea with minimum exertion in daily activities, sporadic orthopnoea. Echocardiogram associated with CPAP was performed to determine ideal positive pressure. Cardiopulmonary exercise testing (CPET), six-minute walk test (6MWT), and assessment of respiratory muscle strength and of quality of life before and after two months of aerobic training were conducted. Testing was performed on a treadmill (HR between thresholds 1 and 2 of CPET) associated with CPAP (6 cm H₂O) for 40 minutes 3x/week. Results: Increased peak oxygen consumption (11%); distance covered in the 6MWT (168m); inspiratory (158%) and expiratory (47%) muscle strength; and improved quality of life with relevant decreased swelling in the legs, decreased pain symptoms and dyspnea. Conclusion: This study has allowed us to provide more information on the optimal positive pressure used for patients with chronic HF and MI participating in a cardiovascular rehabilitation program and its benefits after eight weeks of training by increasing functional capacity, respiratory muscle strength and improved quality of life.