DEMONSTRATIONS OF EXPERIMENTAL WORK IN THE WASHINGTON UNIVERSITY SCHOOL OF MEDICINE: 3. EMPHYSEMA SIMULATING CARDIAC DECOMPENSATION

It has long been held that chronic emphysema sooner or later leads to cardiac failure. This statement appears in many modern textbooks of medicine. It is based largely on the presumption that as the lungs distend during the progression of emphysema, the pulmonary capillaries become stretched and narrowed. Consequently, the blood leaving the right ventricle meets peripheral obstruction, and added work is thrown on the right side of the heart which eventually hypertrophies, dilates and fails. This theory is founded on the clinical fact that patients with advanced emphysema usually have dyspnea on exertion, cyanosis and dependent edema, which are cardinal signs of cardiac decompensation. In a previous study, fifty patients with long-standing bronchial asthma were examined. All of these had emphysema which, in some, was advanced. Particular attention was paid to the cardiovascular system, and little evidence of inherent cardiac damage was obtained. This led to the present study