CIRCULATORY CHANGES IN SEVERE PULMONARY EMPHYSEMA

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Abstract
24 patients with pulmonary emphysema with grossly abnormal respiratory function were studied. Catheterization studies revealed normal or moderately raised right ventricular pressures in the absence of failure. In the presence of failure, the pressure was raised in every case. With recovery from failure right ventricular pressures return toward normal. Pulmonary hypertension was shown to be reversible. The high systolic pulmonary arterial pressures in congestive heart failure were associated with low arterial O2 saturation, but the correction of anoxia by O2 admn. did not usually lower the pressure. Exercise produced a transient increase in systolic pulmonary arterial pressure, indicating that pulmonary hypertension may be due to increased blood flow. Under resting conditions there was no correlation between the level of pressure and the cardiac index. An increase in red cell volume may contribute to pulmonary hypertension. A-V O2 differences were normal in all but 2 cases, regardless of failure. Elevated cardiac outputs were usually the result of an increase in resting O2 consumption. Digitalis was used in 5 patients. Right ventricular pulse pressure was increased without change in cardiac output. The maintenance of a high pulse pressure with lower diastolic filling pressure probably signifies some improvement in myocardial function.