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(Circulation. 1998;98:377.)
© 1998 American Heart Association, Inc.

Correspondence

Respiratory Patterns and Chronic Heart Failure

Ernest H. Friedman, MD

Department of Medicine and Psychiatry, Case Western Reserve University, Cleveland, Ohio

To the Editor:

A primary rhythm in the central nervous system that entrains both heart rate, blood pressure, and ventilation¹ is suggested by profound effects on angina through consciously focusing on breathing and intervening pauses; adaptation to stress manifested by slower, deeper breathing, contributing to a 6.5-fold reduction in mortality; and the role of a slower rate of living in a lifespan increased 5-fold.² This hypothesis is supported by the association of the reduction of blood pressure with longer, less recurrent speech hesitation pauses 1 second or more in length, manifested by pauses averaging 1.18 seconds at >2 per minute and 1.93 seconds at 1 per minute, thus yielding a ratio of 0.611, approximating the golden section 0.618 (range, 0.534 to 0.833). It is also supported by the fact that even brief (1–5-second) spontaneous pauses in ongoing patterned behaviors are accompanied by an immediate reduction of 5-hydroxytryptamine neuronal activity to or below baseline levels, coordinating autonomic, motor, and sensory functions³ and serotonergic modulation of dopamine⁴ lateralized to the right hemisphere, thereby preventing disruption of brain stem cardiovascular control and left-hemisphere dominance associated with hazardous surges of sympathetic tone in abnormal awake respiratory patterns that are common in chronic heart failure manifested by cardiac dysrhythmia and vasoconstriction.^{1 2}

References

1. Mortara A, Sleight P, Pinna GD, Maestri R, Prpa A, La Rovere MT, Cobelli F, Tavazzi L. Abnormal awake respiratory patterns are common in chronic heart failure and may prevent evaluation of autonomic tone by measures of heart rate variability. Circulation. 1997;96:246–252.[Abstract/Free Full Text]
   
2. Friedman EH. Neurobiology of sleep suppression of ventricular arrhythmias. Eur Heart J. 1997;18:349–350. Letter.[Free Full Text]
   
3. Friedman EH. Behavioral correlates of coronary risk. Psychother Psychosom. 1997;66:111. Letter.[Medline] [Order article via Infotrieve]
   
4. Smith GS, Dewey SL, Brodie JD, Logan J, Vitkun SA, Simkowitz P, Schloesser R, Alexoff DA, Hurley A, Cooper T, Volkow ND. Serotonergic modulation of dopamine measured with [¹¹C]Raclopride and PET in normal human subjects. Am J Psychiatry. 1997;154:490–496.[Abstract]
   

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