Bendopnea: Definition, Types, Causes and Diagnosis of This Symptom of Heart Failure

It is a symptom that appears in some patients with very advanced heart failure.

Dyspnea is frequently reported by the elderly, and it is the most commonly reported symptom by patients with heart failure, although with low specificity.

Shortness of breath can occur quite frequently at rest, but more commonly it tends to occur with some type of activity or body position.

This condition is also common in prevalent conditions such as chronic obstructive lung disease, depression , obesity , anemia, and coronary artery disease .

Types of dyspnea

The pathophysiology of dyspnea is complex, with various etiologies and mechanisms. Among the different types of dyspnea, the most common are exertional dyspnea, paroxysmal nocturnal dyspnea, and orthopnea.

A new type has recently been described in patients with heart failure: bendopnea, which is shortness of breath when bending forward, normally associated with increased echocardiographic indices of left-sided filling pressures of the heart.

It is a dominant symptom in patients with heart failure and is generally subclassified based on the nature of the activity that causes its appearance.

Origin of the term

Cardiologists at the University of Texas (Thibodeau JT, Turer AT, Gualano SK, and others), conducted hemodynamic studies in patients with heart failure and coined the term “bendopnea” to describe the many patients who develop difficulty breathing specifically when they bend over. forward, like when they put on their shoes and socks.

The researchers used the term “bendopnea” to describe the phenomenon and stated that knowledge of the symptom can provide clinicians with a simple and non-invasive means of diagnosing excessive fluid retention in patients with the disease.

To determine whether the patients actually had bendopnea, a symptom, they defined shortness of breath within 30 seconds of leaning forward.

The patients were instructed to bend forward at the waist while sitting, and a researcher timed how quickly the patient reported breathing problems.

Bendopnea patients had too much fluid in their bodies, causing high pressure, and when they leaned forward, the pressure increased even more.

Causes of bendopnea

Bendopnea is shortness of breath associated with bending over and has become a tell-tale symptom of congestive heart failure .

It appears to be caused by a further increase in filling pressures when bending in heart failure patients, especially when the filling pressures are already high and the cardiac index is reduced.

Diagnosis  of bendopnea

For most physicians, it can sometimes be difficult to assess whether a patient has fluid retention, and the bendopnea assessment can be an additional tool that can be used to aid in the assessment.

If a heart failure patient experiences shortness of breath when he leans forward to tie his shoelaces or put on a sock, it could be a sign that his disease is progressing and is being overlooked.

Heart failure is often associated with increased intra-abdominal pressure, and it has been suggested to play a hemodynamic role in worsening kidney function with treatment of heart failure.

Intra-abdominal pressure is well studied in critically ill patients and changes with posture.

Furthermore, external abdominal pressure, as applied when testing for hepatojugular ‘reflux’, has been shown to increase cardiac filling pressure in patients with congestive heart failure to a degree remarkably similar to that found by the current authors in patients with dyspnea on bending. The abdomen.

Another similarity is the observation that external abdominal pressure produces its effect on cardiac presenting pressure within 10 seconds of application, and dyspnea on bending occurs at a median of 8 seconds from flexion.

Thus, the mechanism could well be explained by an increase in an already elevated abdominal pressure caused by flexion, perhaps with a compression component or mechanical upward displacement of a congested liver.

Further studies on this phenomenon should document the presence of hepatomegaly and could use transvesicular pressure measurements using a pressure transducer connected to a Foley catheter, as previously described in patients with heart failure.

Bendopnea was the only type of dyspnea not related to respiratory disease or coronary disease.

Even after adjusting for depression and body mass index, the association remained with heart failure with or without preserved ejection fraction, and bendopnea appears to be a promising symptom to differentiate heart failure from the other two disease groups.