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Therapeutic update: Non-selective beta- and alpha-adrenergic blockade in patients with coexistent chronic obstructive pulmonary disease and chronic heart failure

Tseday E. Sirak, MD^*, Sanja Jelic, MD and Thierry H. Le Jemtel, MD^,*

^* Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA
Division of Cardiology, Albert Einstein College of Medicine, Bronx, New York, USA

View larger version (32K): [in a new window]   Figure 1 The top panel (A) depicts the resting cardiopulmonary abnormalities that are responsible for a restrictive ventilatory defect in patients with chronic heart failure (CHF). When patients with CHF exercise, restrictive ventilatory defect, increased dead space (VD/VT) and carbon dioxide production (VCO2), and decreased partial arterial pressure of carbon dioxide (PaCO2) lead to ventilation/perfusion mismatch and worsened gas exchange and lung-diffusing capacity for carbon monoxide (DLCO). The bottom panel (B) depicts the pulmonary abnormalities that are responsible for obstructive ventilatory defect in patients with chronic obstructive pulmonary disease (COPD). When these patients exercise, obstructive ventilatory defect, dynamic hyperinflation, increased respiratory rate and PaCO2 as well as decreased partial arterial pressure of oxygen (PaO2) lead to increased ventilation/perfusion mismatch, decreased gas exchange, and DLCO that compound the effects of CHF on these same parameters (CHF+COPD). = increased; = decreased; = unchanged.