[Study on the genesis of posturally induced crackles from hemodynamic data--in patients with ischemic heart disease...

The presence of fine crackles is suggestive of heart failure in patients without pulmonary disease. We have been interested in the clinical observation that fine crackles are frequently detected when posture was changed from sitting to supine positions or in patients going from sitting position to supine position with passive legs elevation in patients without obvious evidence of heart failure. We named these crackles, "the posturally induced crackles (PIC)". We have already reported that PIC was frequently detected in patients with ischemic heart disease. The present study was performed to estimate the mechanism of the genesis of PIC and to clarify its significance. Seventy-three patients with ischemia heart disease were included in this study. Pulmonary sounds were auscultated in sitting and supine positions and during passive elevation of both legs in a supine position. Patients were divided into 3 groups according to the presence or absence of fine crackles, i.e., those in whom fine crackles were not detected in either position (PIC (-)), those in whom fine crackles were detected in a supine position or during passive elevation of both legs, but not in a sitting position (PIC (+)), and those in whom fine crackles were detected even in a sitting position (Persistent crackles). We measured various hemodynamic parameters (cardiac index, RA pressure, PA pressure and PAW) and parameters of pulmonary circulation (pulmonary blood volume, pulmonary "venous" compliance) in these 3 groups and comparisons were made between them.(ABSTRACT TRUNCATED AT 250 WORDS)