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CHRONIC COR PULMONALE: Sixty Cases Studied at Necropsy

CHRONIC COR PULMONALE: Sixty Cases Studied at Necropsy Abstract COR PULMONALE is usually classified into the acute, subacute and chronic types. Acute cor pulmonale is generally caused by massive pulmonary emboli. If over 60 per cent of the vascular bed is occluded in this form, death will result almost immediately. The subacute form, the least frequent of the three, has been accurately described by Greenspan.1 Secondary endolymphatic carcinomatosis of the lungs is the commonest cause of subacute cor pulmonale. In this condition the metastatic carcinoma diffusely infiltrates the perivascular lymphatics and then secondarily involves the pulmonary arterioles. This involvement interferes with the flow of blood through the pulmonary circuit and results in an increased burden on the right ventricle with eventual failure. The primary site for this type of secondary carcinomatous involvement of the lung is most often in the stomach, but in our experience carcinoma arising in the prostate, liver, kidney, breast or bronchus has also given References 1. Greenspan, E. B.: Carcinomatous Endarteritis of Pulmonary Vessels Resulting in Failure of Right Ventricle , Arch. Int. Med. 54:625-644 ( (Oct.) ) 1934.Crossref 2. Brill, I. C., and Robertson, T. D.: Subacute Cor Pulmonale , Arch. Int. Med. 60:1043-1057 ( (Dec.) ) 1937.Crossref 3. Yater, W. M., and Hansmann, G. H.: Sickle Cell Anemia: New Cause of Cor Pulmonale; Report of Two Cases with Numerous Disseminated Occlusions of Small Pulmonary Arteries , Am. J. M. Sc. 191:474-484 ( (April) ) 1936.Crossref 4. Warthin, A. S.: Syphilis of the Pulmonary Artery , Am. J. Syph. 1:693 ( (Oct.) ) 1917. 5. Cheney, G.: Ayerza's Disease: Report of Two Cases , Am. J. M. Sc. 174:34-45 ( (July) ) 1927.Crossref 6. Eichler, B.: Personal communication to the authors; to be published. 7. Delp, M. H., and Maxwell, R.: Aneurysm of Aorta with Rupture into Pulmonary Artery , J. A. M. A. 10:1647-1649 ( (May 14) ) 1938.Crossref 8. Clark, E., and Graef, I.: Chronic Pulmonary Arteritis in Schistosomiasis Mansoni Associated with Right Ventricular Hypertrophy: Report of a Case , Am. J. Path. 11:693-706 ( (July) ) 1935. 9. Shaw, A. F. B., and Ghareeb, A. A.: The Pathogenesis of Pulmonary Schistosomiasis in Egypt with Special Reference to Ayerza's Disease , J. Path. & Bact. 46:401-424 ( (May) ) 1938. 10. Ketterer, C. H.: Anthracosis and Chronic Pulmonary Heart Disease (Cor Pulmonale) , M. Bull. Vet. Admin. 18:98-100 ( (July) ) 1941. 11. Helpern, M.: Personal communication to the authors 12. Hamman, L., and Rich, A. R.: Acute Diffuse Interstitial Fibrosis of Lungs , Bull. Johns Hopkins Hosp. 74:177-212 ( (March) ) 1944. 13. Willius, F. A.: Cardiac Hypertrophy and Failure Secondary to Diffuse Bilateral Congenital Cystic Disease of Lungs , Proc. Staff Meet., Mayo Clin. 12: 572-575 ( (Sept. 8) ) 1937. 14. Scott, R. W., and Garvin, C. F.: Cor Pulmonale: Observations in Fifty Autopsy Cases , Am. Heart J. 22:56-63 ( (July) ) 1941. 15. Hertzog, A. J., and Manz, W. R.: Right-Sided Hypertrophy (Cor Pulmonale) Caused by Chest Deformity , Am. Heart J. 25:399-403 ( (March) ) 1943. 16. Chapman, E. M.; Dill, D. B., and Graybiel, A.: The Decrease in Functional Capacity of the Lungs and Heart Resulting from Deformities of the Chest: Pulmonocardiac Failure , Medicine 18:167-202 ( (May) ) 1939. 17. Hallock, P., and Rigler, L. G.: Chronic Cor Pulmonale , Staff Meet. Bull., Hosp. Univ. Minnesota 13:106, 1941 18. Am. J. Roentgenol. 50:453-460 ( (Oct.) ) 1943. 19. Brill, I. C., and Krygier, J. J.: Primary Pulmonary Vascular Sclerosis , Arch. Int. Med. 68:560-577 ( (Sept.) ) 1941. 20. Ayerza, L.: Ayerza's Disease: "Black Cardiacs," Rev. Soc. de med. int. 1:73-83 1925. 21. Montgomery, G. I.: A Case of Pulmonary Artery Thrombosis with Ayerza's Syndrome , J. Path. & Bact. 41:221-230 ( (Sept.) ) 1935. 22. Balboni, V. G.: Multiple Pulmonary Thrombi Associated with Cyanosis and Right-Sided Hypertrophy , New England J. Med. 223:896-900 ( (Nov. 28) ) 1940. 23. Brenner, O.: Sclerosis of Pulmonary Artery with Thrombosis , Lancet 1:911-914 ( (April 25) ) 1931.Crossref 24. Parker, R. L.: Pulmonary Emphysema: Relation to Heart and Pulmonary Arterial System , Ann. Int. Med. 14:795-809 ( (Nov.) ) 1940.Crossref 25. Chapman, E. M.: Acute Silicosis , J. A. M. A. 98:1439-1441 ( (April 23) ) 1932.Crossref 26. Rehfisch: Zur Aetiologie der Vergrösserung der rechten Herzkammer, insbesondere bei behindeter Nasenatmung , Deutsche med. Wchnschr. 44:227, 1918. 27. Wood, D. A., and Miller, M.: Role of Dual Pulmonary Circulation in Various Pathologic Conditions of Lungs , J. Thoracic Surg. 7:649-670 ( (Aug.) ) 1938. 28. Higgins, G. K.: The Effect of Pulmonary Tuberculosis upon the Weight of the Heart , Am. Rev. Tuberc. 49:255-275 ( (March) ) 1944. 29. Zadek, I.: Die Polycythämien , Ergebn. d. ges. Med. 10:355-400, 1927. 30. Fishberg, A. M.: Heart Failure , ed 4, Philadelphia, Lea & Febiger, 1940, p. 357. 31. Hess, L., and Saxl, P., cited by Downey, H.: Handbook of Hematology , New York, Paul B. Hoeber, Inc., 1938, p. 2392. 32. Peacock, H. A.: Blood Pressure and Blood Volume in Cases of Polycythemia Vera , Proc. Staff Meet., Mayo Clin. 4:286-288 ( (Sept. 25) ) 1929. 33. Kountz, W. B.; Pearson, E. F., and Koenig, K. F.: Observations on Intrapleural Pressure and Its Influence on the Relative Circulation Rate in Emphysema , J. Clin. Investigation 11:1281-1291 ( (Nov.) ) 1932.Crossref 34. Kountz, W. B.; Alexander, H. L., and Prinzmetal, M.: The Heart in Emphysema , Am. Heart J. 11:163-172 ( (Feb.) ) 1936.Crossref 35. Neergard, K., and Wirz, K.: Die Messung der Strömungswiderstände in den Atemwegen des Menschen in besondere bei Asthma und Emphysem , Ztschr. f. klin. Med. 105:51-82, 1927. 36. Maier, H.: Personal communication to the authors. 37. Eppinger, H.: Das Emphysem der Lungen , Vrtljschr. f. d. prakt. Heilk. 4:1-80, 1876. 38. Herrmann, G. R.: Experimental Heart Disease: Methods of Dividing Hearts with Sectional and Proportional Weights and Ratios for Two Hundred Normal Dogs' Hearts , Am. Heart J. 1:213-231 ( (Dec.) ) 1925.Crossref 39. Roberts, J. E., and Lisa, J. R.: Heart in Pulmonary Tuberculosis: Clinico-Pathological Study of One Hundred Autopsied Patients , Am. Rev. Tuberc. 47: 253-262 ( (March) ) 1943. 40. Ackerman, L. V., and Kasuga, K.: Chronic Cor Pulmonale: Its Relation to Pulmonary Tuberculosis , Am. Rev. Tuberc. 43:11-30 ( (Jan.) ) 1941. 41. Schiller, I. W.; Colmes, A., and Davis, D.: The Occurrence of Cor Pulmonale in Cases of Bronchial Asthma , New England J. Med. 228:113-117 ( (Jan. 28) ) 1943.Crossref 42. Huber, H. L., and Koessler, K. K.: The Pathology of Bronchial Asthma , Arch. Int. Med. 30:688-760 ( (Dec.) ) 1922.Crossref 43. Smith, H. L., and Bartels, E. C.: Gross Cardiac Hypertrophy in Myocardial Infarction , Am. J. M. Sc. 184:452-455 ( (Oct.) ) 1932.Crossref 44. Bland, E. F.; White, P. D., and Garland, J.: Congenital Anomalies of Coronary Arteries , Am. Heart J. 8:787-801 ( (Aug.) ) 1933.Crossref 45. Vacek, T.: Functional Adaptation of the Heart in Mice Living Under Insufficient Oxygen Supply , Arch. f. d. ges. Physiol. 212:357-364, 1926.Crossref 46. Boland, E. W., and Willius, F. A.: Changes in Liver Produced by Chronic Passive Congestion with Special Reference to the Problem of Cardiac Cirrhosis , Arch. Int. Med. 62:723-739 ( (Nov.) ) 1938.Crossref 47. Brill, I. C.: The Clinical Manifestations of the Various Types of Right-Sided Heart Failure (Cor Pulmonale) , Ann. Int. Med. 13:513-522 ( (Sept.) ) 1939.Crossref 48. Weber, F. P.: Secondary Forms of Polycythemia Rubra—Ayerza's Disease , Brit. M. J. 2:658-660 ( (Oct. 30) ) 1920.Crossref 49. Kountz, W. B., and Alexander, H. L.: Emphysema , Medicine 13:251-316 ( (Sept.) ) 1934.Crossref 50. Parkinson, J., and Hoyle, C.: Heart in Emphysema , Quart. J. Med. 6:59-86 ( (Jan.) ) 1937. 51. Goldberger, E.: The Electrocardiographic Diagnosis of Right Ventricular Hypertrophy , Bull. New York Acad. Med. 20:419-420 ( (July) ) 1944. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

CHRONIC COR PULMONALE: Sixty Cases Studied at Necropsy

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References (28)

Publisher
American Medical Association
Copyright
Copyright © 1946 American Medical Association. All Rights Reserved.
ISSN
0730-188X
DOI
10.1001/archinte.1946.00210360042004
Publisher site
See Article on Publisher Site

Abstract

Abstract COR PULMONALE is usually classified into the acute, subacute and chronic types. Acute cor pulmonale is generally caused by massive pulmonary emboli. If over 60 per cent of the vascular bed is occluded in this form, death will result almost immediately. The subacute form, the least frequent of the three, has been accurately described by Greenspan.1 Secondary endolymphatic carcinomatosis of the lungs is the commonest cause of subacute cor pulmonale. In this condition the metastatic carcinoma diffusely infiltrates the perivascular lymphatics and then secondarily involves the pulmonary arterioles. This involvement interferes with the flow of blood through the pulmonary circuit and results in an increased burden on the right ventricle with eventual failure. The primary site for this type of secondary carcinomatous involvement of the lung is most often in the stomach, but in our experience carcinoma arising in the prostate, liver, kidney, breast or bronchus has also given References 1. Greenspan, E. B.: Carcinomatous Endarteritis of Pulmonary Vessels Resulting in Failure of Right Ventricle , Arch. Int. Med. 54:625-644 ( (Oct.) ) 1934.Crossref 2. Brill, I. C., and Robertson, T. D.: Subacute Cor Pulmonale , Arch. Int. Med. 60:1043-1057 ( (Dec.) ) 1937.Crossref 3. Yater, W. M., and Hansmann, G. H.: Sickle Cell Anemia: New Cause of Cor Pulmonale; Report of Two Cases with Numerous Disseminated Occlusions of Small Pulmonary Arteries , Am. J. M. Sc. 191:474-484 ( (April) ) 1936.Crossref 4. Warthin, A. S.: Syphilis of the Pulmonary Artery , Am. J. Syph. 1:693 ( (Oct.) ) 1917. 5. Cheney, G.: Ayerza's Disease: Report of Two Cases , Am. J. M. Sc. 174:34-45 ( (July) ) 1927.Crossref 6. Eichler, B.: Personal communication to the authors; to be published. 7. Delp, M. H., and Maxwell, R.: Aneurysm of Aorta with Rupture into Pulmonary Artery , J. A. M. A. 10:1647-1649 ( (May 14) ) 1938.Crossref 8. Clark, E., and Graef, I.: Chronic Pulmonary Arteritis in Schistosomiasis Mansoni Associated with Right Ventricular Hypertrophy: Report of a Case , Am. J. Path. 11:693-706 ( (July) ) 1935. 9. Shaw, A. F. B., and Ghareeb, A. A.: The Pathogenesis of Pulmonary Schistosomiasis in Egypt with Special Reference to Ayerza's Disease , J. Path. & Bact. 46:401-424 ( (May) ) 1938. 10. Ketterer, C. H.: Anthracosis and Chronic Pulmonary Heart Disease (Cor Pulmonale) , M. Bull. Vet. Admin. 18:98-100 ( (July) ) 1941. 11. Helpern, M.: Personal communication to the authors 12. Hamman, L., and Rich, A. R.: Acute Diffuse Interstitial Fibrosis of Lungs , Bull. Johns Hopkins Hosp. 74:177-212 ( (March) ) 1944. 13. Willius, F. A.: Cardiac Hypertrophy and Failure Secondary to Diffuse Bilateral Congenital Cystic Disease of Lungs , Proc. Staff Meet., Mayo Clin. 12: 572-575 ( (Sept. 8) ) 1937. 14. Scott, R. W., and Garvin, C. F.: Cor Pulmonale: Observations in Fifty Autopsy Cases , Am. Heart J. 22:56-63 ( (July) ) 1941. 15. Hertzog, A. J., and Manz, W. R.: Right-Sided Hypertrophy (Cor Pulmonale) Caused by Chest Deformity , Am. Heart J. 25:399-403 ( (March) ) 1943. 16. Chapman, E. M.; Dill, D. B., and Graybiel, A.: The Decrease in Functional Capacity of the Lungs and Heart Resulting from Deformities of the Chest: Pulmonocardiac Failure , Medicine 18:167-202 ( (May) ) 1939. 17. Hallock, P., and Rigler, L. G.: Chronic Cor Pulmonale , Staff Meet. Bull., Hosp. Univ. Minnesota 13:106, 1941 18. Am. J. Roentgenol. 50:453-460 ( (Oct.) ) 1943. 19. Brill, I. C., and Krygier, J. J.: Primary Pulmonary Vascular Sclerosis , Arch. Int. Med. 68:560-577 ( (Sept.) ) 1941. 20. Ayerza, L.: Ayerza's Disease: "Black Cardiacs," Rev. Soc. de med. int. 1:73-83 1925. 21. Montgomery, G. I.: A Case of Pulmonary Artery Thrombosis with Ayerza's Syndrome , J. Path. & Bact. 41:221-230 ( (Sept.) ) 1935. 22. Balboni, V. G.: Multiple Pulmonary Thrombi Associated with Cyanosis and Right-Sided Hypertrophy , New England J. Med. 223:896-900 ( (Nov. 28) ) 1940. 23. Brenner, O.: Sclerosis of Pulmonary Artery with Thrombosis , Lancet 1:911-914 ( (April 25) ) 1931.Crossref 24. Parker, R. L.: Pulmonary Emphysema: Relation to Heart and Pulmonary Arterial System , Ann. Int. Med. 14:795-809 ( (Nov.) ) 1940.Crossref 25. Chapman, E. M.: Acute Silicosis , J. A. M. A. 98:1439-1441 ( (April 23) ) 1932.Crossref 26. Rehfisch: Zur Aetiologie der Vergrösserung der rechten Herzkammer, insbesondere bei behindeter Nasenatmung , Deutsche med. Wchnschr. 44:227, 1918. 27. Wood, D. A., and Miller, M.: Role of Dual Pulmonary Circulation in Various Pathologic Conditions of Lungs , J. Thoracic Surg. 7:649-670 ( (Aug.) ) 1938. 28. Higgins, G. K.: The Effect of Pulmonary Tuberculosis upon the Weight of the Heart , Am. Rev. Tuberc. 49:255-275 ( (March) ) 1944. 29. Zadek, I.: Die Polycythämien , Ergebn. d. ges. Med. 10:355-400, 1927. 30. Fishberg, A. M.: Heart Failure , ed 4, Philadelphia, Lea & Febiger, 1940, p. 357. 31. Hess, L., and Saxl, P., cited by Downey, H.: Handbook of Hematology , New York, Paul B. Hoeber, Inc., 1938, p. 2392. 32. Peacock, H. A.: Blood Pressure and Blood Volume in Cases of Polycythemia Vera , Proc. Staff Meet., Mayo Clin. 4:286-288 ( (Sept. 25) ) 1929. 33. Kountz, W. B.; Pearson, E. F., and Koenig, K. F.: Observations on Intrapleural Pressure and Its Influence on the Relative Circulation Rate in Emphysema , J. Clin. Investigation 11:1281-1291 ( (Nov.) ) 1932.Crossref 34. Kountz, W. B.; Alexander, H. L., and Prinzmetal, M.: The Heart in Emphysema , Am. Heart J. 11:163-172 ( (Feb.) ) 1936.Crossref 35. Neergard, K., and Wirz, K.: Die Messung der Strömungswiderstände in den Atemwegen des Menschen in besondere bei Asthma und Emphysem , Ztschr. f. klin. Med. 105:51-82, 1927. 36. Maier, H.: Personal communication to the authors. 37. Eppinger, H.: Das Emphysem der Lungen , Vrtljschr. f. d. prakt. Heilk. 4:1-80, 1876. 38. Herrmann, G. R.: Experimental Heart Disease: Methods of Dividing Hearts with Sectional and Proportional Weights and Ratios for Two Hundred Normal Dogs' Hearts , Am. Heart J. 1:213-231 ( (Dec.) ) 1925.Crossref 39. Roberts, J. E., and Lisa, J. R.: Heart in Pulmonary Tuberculosis: Clinico-Pathological Study of One Hundred Autopsied Patients , Am. Rev. Tuberc. 47: 253-262 ( (March) ) 1943. 40. Ackerman, L. V., and Kasuga, K.: Chronic Cor Pulmonale: Its Relation to Pulmonary Tuberculosis , Am. Rev. Tuberc. 43:11-30 ( (Jan.) ) 1941. 41. Schiller, I. W.; Colmes, A., and Davis, D.: The Occurrence of Cor Pulmonale in Cases of Bronchial Asthma , New England J. Med. 228:113-117 ( (Jan. 28) ) 1943.Crossref 42. Huber, H. L., and Koessler, K. K.: The Pathology of Bronchial Asthma , Arch. Int. Med. 30:688-760 ( (Dec.) ) 1922.Crossref 43. Smith, H. L., and Bartels, E. C.: Gross Cardiac Hypertrophy in Myocardial Infarction , Am. J. M. Sc. 184:452-455 ( (Oct.) ) 1932.Crossref 44. Bland, E. F.; White, P. D., and Garland, J.: Congenital Anomalies of Coronary Arteries , Am. Heart J. 8:787-801 ( (Aug.) ) 1933.Crossref 45. Vacek, T.: Functional Adaptation of the Heart in Mice Living Under Insufficient Oxygen Supply , Arch. f. d. ges. Physiol. 212:357-364, 1926.Crossref 46. Boland, E. W., and Willius, F. A.: Changes in Liver Produced by Chronic Passive Congestion with Special Reference to the Problem of Cardiac Cirrhosis , Arch. Int. Med. 62:723-739 ( (Nov.) ) 1938.Crossref 47. Brill, I. C.: The Clinical Manifestations of the Various Types of Right-Sided Heart Failure (Cor Pulmonale) , Ann. Int. Med. 13:513-522 ( (Sept.) ) 1939.Crossref 48. Weber, F. P.: Secondary Forms of Polycythemia Rubra—Ayerza's Disease , Brit. M. J. 2:658-660 ( (Oct. 30) ) 1920.Crossref 49. Kountz, W. B., and Alexander, H. L.: Emphysema , Medicine 13:251-316 ( (Sept.) ) 1934.Crossref 50. Parkinson, J., and Hoyle, C.: Heart in Emphysema , Quart. J. Med. 6:59-86 ( (Jan.) ) 1937. 51. Goldberger, E.: The Electrocardiographic Diagnosis of Right Ventricular Hypertrophy , Bull. New York Acad. Med. 20:419-420 ( (July) ) 1944.

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Jan 1, 1946

There are no references for this article.