Cor Pulmonale (Pulmono-Cardiac Syndrome) A Case Report

Lewis, Ceylon S.; Daines, Merrill C.; Samuels, Arthur J.; Hecht, Hans H.

doi:10.1378/chest.22.3.261

Cited by 9 publications

(4 citation statements)

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“…In fact the presence of only a slight increase in medial thickness in the pulmonary arteries to a value barely exceeding 5 per cent of the external diameter of the vessels is characteristic of pulmonary vascular changes associated with most cases of cor pulmonale due to primary lung disease.7 This is probably due to the fact that the pulmonary artery blood pressure in these diseases is usually elevated only during the periods of congestive cardiac failure associated with respiratory infections.8 Exceptionally, even in primary lung disease, the pulmonary vascular resistance may be chronically elevated to high levels and severe vascular changes would then be expected. 9 We consider that this patient had anoxic cor pulmonale that developed as a result of the skeletal deformities of her chest, similar to the group of patients with kyphoscoliotic heart disease described by Hanley and his associates.10 These workers have shown that patients with kyphoscoliosis may present with the clinical picture of anoxic cor pulmonale, the total lung capacity and vital capacity being reduced to as little as one quarter of normal. In the present case there was thoracic deformity with small lungs, emphysema was absent, and the vital capacity was only 1,300 ml.…”

supporting

confidence: 67%

Gonadal Dysgenesis with Cor Pulmonale

Davidson

Heath

1960

Circulation

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The clinical and pathologic features of a 37-year-old patient with Turner's syndrome are described. Dyspnea developed in the third decade and respiratory signs and symptoms finally dominated the clinical picture, so that the case appeared terminally as one of anoxic cor pumonale. The heart failure is considered to be related to the kyphoscoliosis present as one of the skeletal deformities of the syndrome.

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supporting

confidence: 67%

Gonadal Dysgenesis with Cor Pulmonale

Davidson

Heath

1960

Circulation

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“…Necropsy reports on patients with thoracic spinal deformities often stress the occurrence of collapsed and underdeveloped segments of lung (Kerwin, 1942: Lewis, Daines, Samuels, andHecht, 1952;Fischer and Dolehide, 1954), and it is possible that these might allow unoxygenated blood to pass to the left side of the heart. In the present series a large shunt was excluded in at least two of the subjects (Cases 1 and 4), because their arterial oxygen saturations rose from 86 and 88% to over 100% after inhaling pure oxygen through a valve box.…”

Section: Discussionmentioning

confidence: 99%

Hypoxia and Thoracic Scoliosis

Shaw¹,

Read²

1960

BMJ

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The incidence of lobar pneumonia rose with age, segmental pneumonia was most frequent in young children, and acute bronchitis was most often found in the young and the elderly. Similar facts were observed in the report of the College of General Practitioners (1956). These three clinical conditions also had quite dilTerent disability rates at follow-up. The highest disability rate was found in those who had suffered from acute bronchitis (71 %), and the lowest in those with segmental pneumonias (16%); that for lobar pneumonia was in between (42%). It was also found that the lower social classes were more likely to suffer from these acute chest infections, whereas only II% of the practice population belonged to classes IV and V; 44% of the patients with these chest infections were in these two groups.When the disabled group was analysed in an attempt to answer the questions who was disabled and why, some pointers emerged. Of those disabled 63% (118 out of 187) were over the age of 40. The disability rate for males (47%) was only a little higher than that for females (40%). It was very difficult to interpret the role of smoking because while 90% of disabled men were smokers (but then more than 76% of men in the London area are smokers) only 40% of the disabled women were srmokers (in London 48% of women are smokers).It may well be that men were more susceptible to the effects of smoking and that they smoked more, or that women found it easier to give up once symptoms developed. More studies are obviously necessary to clear up this point.The disabled group contained 53 % in social classes IV and V. whereas only 11% of the practice were in these two classes. It seems fairly definite that the lower social groups are more likely to suffer disability after pneumonias and acute bronchitis. A previous history of chest trouble also had a marked adverse effect on the prognosis. The disability rate in those with such a history was 71 %-almost twice that for the whole series, which was 40%.A picture thus builds up that those most likely to develop disabilities from chest infections are men over 40 who smoke, who belong to social classes TV and V, and who have a previous history of chest troubles. There are also other factors which have not been taken into account here, but which must be considered-the environmental effects, such as atmospheric pollution, and occupational risks and genetic and familial influences. The treatment given may also play a part in influencing the ultimate course of the condition. All these facts require further assessment by planned long-term studies before prevention can be attempted. Summary 424 patients who suffered from pneumonia or acute bronchitis in 1949-54 were followed up for 5 to 10 years and reassessed functionally in 1959.As many as 43 % were considered to be disabled according to the method of grading used, 9% were complete invalids, and 24 had died during the acute illness. This rate of disability was more than twice that present (21 %) before the infection S to 10 years earlier.Three d...

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“…This is the third of the triad that is present in heart disease associated with emphysema. This particular type of erythrocytosis usually does not appear until arterial oxygen saturation falls to [70][71][72][73][74][75] Lnemia with It has been claimed that this blocking effect significantly lower than normal and the polycythemic cells are often hypochromic. In summary, the emphysema heart is associated with the triad of pulmonary hypertension, arterial desaturation, and polycythemia.…”

Section: Emphysema Heartmentioning

confidence: 99%

Heart Failure and Lung Disease

Hecht

1956

Circulation

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The confusing and complex interplay of factors leading to "cor pulmonale" may be somewhat clarified if the effects of excessive pulmonary hypertension causing right heart overloading ("pulmonary hypertensive heart disease") are separated from the ventilatory defects that result in arterial desaturation, erythrocytosis, and moderate pulmonary hypertension ("emphysema heart"). In the former group, heart failure dominates the clinical picture; in the latter, it is assumed that heart failure occurs on the basis of a "myocardial factor"—presumably arteriosclerotic heart disease—whose manifestations are colored and modified by the coexisting and contributing respiratory dysfunction. Overlapping of these two distinct forms occurs frequently, and pulmonary hypertension may be severe enough to be the chief precipitating cause of failure in emphysema, particularly in young subjects and in patients with kyphoscoliosis. Respiratory disturbances, fibrosis, and loss of pulmonary elasticity may accompany heart failure secondary to right ventricular overloading which may ultimately lead to significant arterial desaturation at rest and the development of polycythemia, even in this group. It is typical, however, that the disturbances leading to cor pulmonale rarely, if ever, involve the actual pulmonary function of alveolar-capillary gas exchange; they are confined to the abnormalities of the precapillary pulmonary vasculature and to the mechanical apparatus of the chest cage and of the pulmonary parenchyma concerned with breathing mechanisms. Pulmonary hypertensive heart disease, whatever its cause, has a monotonous symptomatology that is dominated by the signs of heart failure. In cor pulmonale due to emphysema and its allied types, the clinical picture is varied, and oxygen deficiency with arterial desaturation is of central significance. It raises pulmonary artery pressure by a mechanism not fully understood, and it stimulates erythropoiesis. When erythrocytosis has occurred, heart failure from cor pulmonale will soon make its appearance. Unless the arterial oxygen content falls sharply on exercise, resting oxygen saturation values in excess of 80 per cent do not cause this type of polycythemia; nor does polycythemia as such, as in erythremia ("vera"), result in significant arterial desaturation, pulmonary hypertension, or heart failure. However, little is known concerning the hemodynamic load imposed by an increase in blood viscosity. The management of cor pulmonale must recognize the multiplicity of factors that are concerned and should weigh their relative significance in any given subject. The kaleidoscopic appearance of cor pulmonale requires flexibility of therapy based on a grasp of the individual pathophysiologic interrelations, which may differ from patient to patient.

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Cor Pulmonale (Pulmono-Cardiac Syndrome) A Case Report

Cited by 9 publications

References 8 publications

Gonadal Dysgenesis with Cor Pulmonale

Gonadal Dysgenesis with Cor Pulmonale

Hypoxia and Thoracic Scoliosis

Heart Failure and Lung Disease

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