At this final step, patients were excluded if they had abnormal findings on a Doppler echocardiogram 7, 8 or high BNP levels (≥80 pg/mL). Finally, all the patients screened at the second step underwent a cardiac Doppler echocardiogram and blood sampling for analysis of serum B-type natriuretic peptide (BNP) levels. At this second step, patients were excluded if they had high serum creatinine levels (≥1.2 mg/dL), abnormal ECG rhythm (atrial fibrillation or left bundle branch block), or radiographic abnormalities. No patient was suspected either clinically or after examination or investigation to suffer from connective tissue diseases.Īll screened patients had a physical examination, blood chemistry tests, a 12-lead electrocardiogram (ECG), and a simple chest radiograph. Patients were not eligible for this investigation if they reported acute cardiopulmonary complaints or if they had a current diagnosis or history of structural heart disease, decompensated heart failure, chronic pulmonary disease, or recent episode (less than 3 months) of acute respiratory disease. Adult out-patients (aged 45 years and older) undergoing treatment for cardiovascular disease, including metabolic syndrome, were first screened by research nurses, who obtained consent and recorded a brief cardiac and pulmonary history and current complaints. This prospective study was performed in the cardiology outpatient clinic of Nishida Hospital (Oita, Japan) between June 2005 and November 2006. In this study we examined the characteristics of pulmonary crackles among adult patients, stratified by decade, with stage A cardiovascular disease status as defined by the American College of Cardiology/American Heart Association 2001 chronic heart failure guidelines, 6 ie, patients at high risk for congestive heart failure, but without structural heart disease or symptoms of heart failure, who were also free from comorbid pulmonary disease. Because diagnostic and therapeutic decisions may be made on the basis of the finding of crackles, knowledge of their occurrence would be clinically important. Frequent age-related pulmonary crackles might interfere with the physician’s management of patients with suspected heart failure or presumed pulmonary disease. 3 – 5 Moreover, little is known about these issues in patients with asymptomatic cardiovascular disease. The prevalence and pathologic importance of crackles in apparently normal persons are controversial. 2 Many older patients with asymptomatic cardiovascular disease seem to have pulmonary crackles, even in the absence of apparent cardiac dysfunction or comorbid pulmonary disease. 1 The appearance of pulmonary crackles (rales), defined as discontinuous, interrupted, explosive respiratory sounds during inspiration, is one of the most important signs of heart failure deterioration. Heart failure is a common problem, especially in elderly patients. The occurrence of cardiopulmonary disease during follow-up included cardiovascular disease in 5 patients and pulmonary disease in 6.ĬONCLUSIONS Recognition of age-related pulmonary crackles (rales) is important because such clinically unimportant crackles are so common among elderly patients that, without knowledge of this phenomenon, their existence might interfere with the physician’s management of cardiopulmonary patients. During a mean follow-up of 11 ± 2.3 months (n = 255), the short-term (≤3 months) reproducibility of crackles was 87%. The risk for audible crackles increased approximately threefold every 10 years after 45 years of age. METHODS After exclusion of comorbid pulmonary and other critical diseases, 274 participants, in whom the heart was structurally (based on Doppler echocardiography) and functionally (B-type natriuretic peptide <80 pg/mL) normal and the lung (X-ray evaluation) was normal, were eligible for the analysis. We examined the characteristics of pulmonary crackles among patients with stage A cardiovascular disease (American College of Cardiology/American Heart Association heart failure staging criteria), stratiffed by decade, because little is known about these issues in such patients at high risk for congestive heart failure who have no structural heart disease or acute heart failure symptoms. PURPOSE The presence of age-related pulmonary crackles (rales) might interfere with a physician’s clinical management of patients with suspected heart failure.
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