Cheyne stokes breathing

This presentation is about mechanism, causes, consequences and management of Cheyne-Stokes breathing.

1. بسم الله الرحمن الرحیم

2. Cheyne -Stokes breathing mechanism, causes, consequences and management

3. Definition This is a form of periodic breathing characterized by alternating periods of central apnea ( or hypopnea) and hyperpnoea. The rate and depth of respiration increase to a maximum over a period of a few minutes, then decrease until breathing virtually ceases. The patient lies motionless for 10-20 seconds (apnea). Then the cycle is repeated .

4. Mechanism Anoxemic abolishes the spontaneous rhythmic activity of breathing. Consequent apnea results in accumulation of carbon dioxide. This hypercapnia stimulates respiratory centers resulting in hyperventilation. The hyperventilation leads to carbon dioxide wash out and results in depression of the respiratory center leading to apnea. The cycle is repeated. Apneas are more severe when the patient is supine because pulmonary congestion worsens on lying flat, which activates afferent receptors present in lung ("J" receptors) and induces hyperventilation.

5. Conditions Associated with Cheyne -Stokes Breathing Severe heart failure Uremia Chronic hypoxia Cerebral trauma and hemorrhage

6. Consequences Increased intracranial pressure Severe pneumonia Narcotic drug poisoning Normal subjects living at high altitude Alternating cycles of hyper- and hypoventilations provoke oscillations in blood pressure, heart rate and tidal volume. This leads to a state of physiological instability in the already stressed cardiovascular system in patients with congestive heart failure (CHF). Poor sleep quality leads to daytime somnolence, fatigue, impaired quality of life and insomnia .

7. Management Treatment of underlying cause. In patients with CHF, theophylline, acetazolamide or benzodiazepines have been used with varying success. Oxygen therapy. Positive pressure ventilation.