Heart Disease of Pulmonary Origin

¹ Cardiovascular Service, University of Texas Medical Branch.

1. Criteria for definite, pure, chronic cor pulmonale have been set down and 51 patients who meet these qualifications were studied. By far, the greatest incidence is in middle aged white males, though it is seen in all ages, both sexes, and in various racial groups.

2. The electrocardiogram shows the changes rather late, and in general was of relatively little value in assessing the degree of cardiac change; yet, the ecg. finding may be the first to focus attention on the presence of a right ventricular overload.

3. Detailed blood volume studies were done in 17 patients with cor pulmonale and six individuals with emphysema, using isotopes I₁₃₁ human serum albumin to determine plasma volume, and Cr₅₁, for estimation of the total red blood cell mass. The emphysema patients were not consistently abnormal, but those with definite cor pulmonale showed a variable increase of total blood volume, and a consistent increase of red blood cell mass.

4. Follow-up studies after digitalization of patients with failure showed decrease in plasma volume invariably, and frequently, a marked inexplicable decrease of red blood cell mass.

5. In management of these patients, we have strongly emphasized the importance of prophylaxis, early recognition, and energetic treatment in the early phases, even before cardiac changes are manifest. We must admit that the patients who have met our criteria represent the most advanced and refractory ones. While the long term prognosis is poor, current drugs and practices offer the patient comfort, ability to work, and probably a longer life span than was previously possible.