Heart Failure in Patients with Chronic Pulmonary Emphysema

¹ Department of Cardiology, Sawai Man Singh Hospital and Medical College

A study of 150 patients with clinical pulmonary emphysema and heart failure is reported. Incidence of cor pulmonale was 16 per cent of all cardiac cases and 23 per cent of cases with heart failure. High incidence of emphysema and heart failure is probably due to lack of proper treatment of recurrent respiratory infections as a result of poverty and ignorance.

In 40 cases, the duration of respiratory symptoms was less than three years. In the majority of them, ischemic heart disease was present and dyspnea was an initial symptom. It is suggested that emphysema in these cases may be partly a consequence of chronic left heart failure and that chronic pulmonary congestion associated with untreated respiratory infections may lead to emphysema in a much shorter duration than bronchopulmonary disease alone.

The electrocardiogram showed evidence of emphysema heart disease in 123 cases, of ischemic heart disease in 48 cases, and of both in 23 cases. Incidence of ischemic heart disease increased with advancing age and appeared to be coincidental in the age population studied. Cardiac arrhythmias other than premature beats and attributable to emphysema heart disease were seen in only four cases. Right ventricular hypertrophy pattern disappeared after relief of failure in some cases showing that it may occur only as a temporary phenomenon and does not necessarily indicate anatomic right ventricular hypertrophy.

Roentgenologically generalized or left ventricular type of cardiac enlargement was seen in 31 of 100 cases with ECG evidence of only emphysema heart disease, and its age incidence was similar to that of ischemic heart disease. It is suggested that even in cases with only emphysema heart disease, but showing left ventricular or generalized cardiac enlargement, ischemic heart disease is probably an important factor in the causation of heart failure.

Diagnosis of cor pulmonale on clinical grounds may be difficult to make in some cases with ischemic heart disease. It is suggested that, for clinical purposes, the term "heart failure in patients with emphysema" is more appropriate than cor pulmonale.