Cheyne-Stokes respiration: poor prognostic sign in a patient with heart failure

Description

Patients with congestive heart failure (CHF) have high incidence of sleep-disordered breathing. Two distinct types are known: obstructive sleep apnoea (OSA) and Cheyne-Stokes respiration (CSR).1 Effective heart failure treatment improves CSR but not OSA, indicating that the development of CSR is secondary to heart failure. CSR is characterised by recurrent episodes of central apnoea/hypopnoea interposed with periods of hyperpnoea with waning and waxing pattern of tidal volume. A 5-month-old girl who presented with acute onset of poor appetite and tachypnoea had cardiomegaly on chest X-ray. Echocardiography showed severely depressed left ventricular (LV) function with ejection fraction of 10%. She was diagnosed with LV non-compaction cardiomyopathy and placed on heart transplant list. Her heart failure management included milrinone infusion, diuretics and digoxin. She subsequently worsened with increasing heart rate and tachypnoea. Her telemetry showed evidence of CSR with clinical and echocardiographic evidence of worsening LV function (

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