CIRCULATORY CHANGES IN SEVERE PULMONARY EMPHYSEMA

Abstract

Normal or even increased cardiac output was shown by McMichael and Sharpey-Schafer (1944) and by Richards (1945) to be present in failure of the circulation secondary to lung disease, and has since been considered as one of the essential features that distinguishes this condition from heart disease primarily affecting the left ventricle. The techniques of cardiac catheterization then in use, however, did not permit detailed analysis of other alterations in circulatory dynamics that might exist. With the introduction of new methods for recording the intra-cardiac pressures it has been possible to extend these studies of the circulatory changes resulting from chronic disease of the lungs and to draw some tentative conclusions as to their mechanism. MATERIALS AND METHODS Selection of Patients. Of a large number of patients with chronic bronchitis and emphysema available, only those suspected of having heart involvement secondary to their pulmonary disease were chosen for investigation. As a consequence, it was recognized that the pulmonary disability of this group would probably be of particularly advanced degree. Co-existing systemic hypertension' or ischoemic heart disease did not bar inclusion in this series, but patients considered to have left ventricular failure from either of these two causes were omitted. Cases of active tuberculosis, marked kyphoscoliosis, or pneumoconiosis were also excluded. On the basis of this selection, the data obtained in 24 patients admitted to Hammersmith Hospital during the past two years were suitable for analysis.