Pulmonary Heart Disease

378 Pages·1984·12.45 MB·English

by  Lewis J. Rubin M.D. (auth.), Lewis J. Rubin M.D. (eds.)

PULMONARY HEART DISEASE
PULMONARY HEART DISEASE
edited by LEWIS J. RUBIN
MARTINUS NI]HOFF PUBLISHING
A MEMBER OF THE KLUWER ACADEMIC PUBLISHERS GROUP
Boston/The Hague /Dordrecht/Lancaster
Copyright 1984 @ by Martinus Nijhoff Publishing, Boston
Softcover reprint of the hardcover 1s t Edition 1984
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system,
or transmitted in any form or by any means, mechanical, photocopying, recording, or otherwise,
without written permission of the publisher, Martinus Nijhoff Publishing, 190 Old Derby Street,
Hingham, Massachusetts 02043
Distributors:
for North America for all other countries
Kluwer Academic Publishers Kluwer Academic Publishers Group
190 Old Derby Street Distribution Centre
Hingham, MA 02043 P.O. Box 322
3300 AH Dordrecht
The Netherlands
Library of Congress Cataloging in publication Data
Main entry under title:
Pulmonary heart disease.
Bibliography: p.
Includes index.
1. Cor pulmonale. I. Rubin, Lewis J. [DNLM:
1. Pulmonary heart disease. WG 420 P975]
RC685.C55P85 1984 616.1'2 84-1523
ISBN-13: 978-1-4612-9797-0 e-ISBN: 978-1-4613-2847-6
DOl: 10.1007/978-1-4613-2847-6
To my mother, Erna Rubin, and in memory of my father, Theodore Rubin.
CONTENTS
Preface xiii
1. Introduction 1
LEWIS J. RUBIN, M.D.
2. Pathophysiology of the pulmonary circulation 11
BRYDON J.B. GRANT, M.D.
DAVID R. DANTZKER, M.D.
3. Pathology of pulmonary heart disease 65
WAYNE E. TAYLOR, M.D.
4. Clinical evaluation 107
LEWIS J. RUBIN, M.D.
5. The electrocardiogram in chronic lung disease 117
FRANCIS X. MCGOWAN, M.D.
GALEN S. WAGNER, M.D.
6. Roentgenographic evaluation of pulmonary heart disease 135
CARL E. RAVIN, M.D.
7. Pulmonary function and exercise testing 177
TIMOTHY R. CHAPPELL, M.D.
8. Radionuclide angiocardiographic assessment of right and left ventricular
performance 223
vii
viii Contents
RICHARD A. MATTHAY, M.D.
HARVEY J. BERGER, M.D.
9. The left ventricle in chronic lung disease 247
EDGAR J. CALDWELL, M.D.
10. Arrhythmias in chronic lung disease 273
ERIC N. PRYSTOWSXY, M.D.
GEORGE KLEIN, M.D.
11. Acute cor pulmonale 285
WARREN R. SUMMER, M.D.
12. Therapy of pulmonary heart disease 325
LEWIS J. RUBIN, M.D.
ROBERT H. PETER, M.D.
13. Prognosis of pulmonary heart disease 355
RUSSELL DODGE, M.D.
BENJAMIN BURROWS,. M.D.
DOUGLASS MORRISON, M.D.
CONTRIBUTING AUTHORS
Harvey J. Berger, M.D.
Assistant Professor of Diagnostic Radiology and Medicine
Director of Cardiovascular Imaging
Yale University School of Medicine
New Haven, CT
Benjamin Burrows, M.D.
Professor of Medicine
Chief, Pulmonary Division
University of Arizona Health Sciences Center
Tucson, AZ
Edgar J. Caldwell, M.D.
Associate Professor of Medicine
University of Vermont School of Medicine
Pulmonary Division, Maine Medical Center
Portland, ME
Timothy R. Chappell, M.D.
Assistant Professor of Internal Medicine
University of Texas Health Science Center at Dallas
Assistant Chief, Pulmonary Section
ix
x Contributing Authors
Veterans Administration Medical Center
Dallas, TX
David R. Dantzker, M.D.
Professor of Medicine
Chief, Pulmonary Division
University of Texas Health Science Center at Houston
Houston, TX
Russell Dodge, M.D.
Assistant Professor of Medicine
Pulmonary Division
University of Arizona Health Sciences Center
Tucson, AZ
Brydon J.B. Grant, M.D.
Assistant Professor of Medicine
Pulmonary Division
State University of New York at Buffalo School of Medicine
Buffalo, NY
George J. Klein, M.D.
Assistant Professor of Medicine
Director, Clinical Electrophysiology Laboratory
Cardiac Investigation Unit
University Hospital
London, Ontario
Canada
Richard A. Matthay, M.D.
Associate Professor of Medicine
Associate Director, Pulmonary Division
Yale University School of Medicine
New Haven, CT
Francis X. McGowan, M.D.
Research Fellow in Cardiology
Department of Medicine
Duke University School of Medicine
Durham, NC
Douglass Morrison, M.D.
Assistant Professor of Medicine and Radiology
University of Arizona Health Sciences Center
xi
Staff Cardiologist, Veterans Administration Medical Center
Tucson, AZ
Robert H. Peter, M.D.
Professor of Medicine
Associate Director, Cardiovascular Laboratory
Duke University School of Medicine
Durham, NC
Eric N. Prystowsky, M.D.
Associate Professor of Medicine
Director, Clinical Electrophysiology Laboratory
Krannert Institute of Cardiology
Indiana University School of Medicine
Indianapolis, IN
Carl E. Ravin, M.D.
Professor of Radiology
Director, Imaging Division
Duke University School of Medicine
Durham, NC
Lewis J. Rubin, M.D.
Assistant Professor of Internal Medicine
University of Texas Health Science Center at Dallas
Chief, Pulmonary Section, Veterans Administration Medical Center
Dallas, TX
Warren R. Summer, M.D.
Professor of Medicine
Chief, Pulmonary-Critical Care Division
Louisiana State University Medical Center
New Orleans, LA
Wayne E. Taylor, M.D.
Assistant Professor of Pathology
University of Texas Health Science Center at Dallas
Dallas, TX
Galen S. Wagner, M.D.
Associate Professor of Medicine
Cardiology Division
Duke University School of Medicine
Durham, NC
PREFACE
Responsibility for the diagnosis and management of disorders of the pulmonary
circulation has become the shared domain of the pulmonologist, cardiologist,
surgeon, radiologist, pathologist, and, perhaps most important of all, the internist.
It is the general internist who is most likely to care for the majority of patients
with lung diseases that secondarily give rise to pulmonary heart disease, and it is
the internist who will first evaluate the patient with primary pulmonary hyperten
sion or recurrent pulmonary thromboembolism who presents with nonspecific
complaints and may manifest subtle and nondiagnostic findings on preliminary
evaluation.
The burgeoning medical literature concerning aspects of the pulmonary circula
tion, both clinical and investigative, is a reflection of the reawakening of great
interest in this field and has led to many new developments, both in our understand
ing of cardiopulmonary pathophysiology and in the diagnosis and treatment of
pulmonary vascular diseases. This book is an attempt to provide the clinician with
a comprehensive overview of pulmonary heart disease from the perspective of
experts representing a variety of disciplines. It is intended to be thorough yet
clinically relevant. Individuals familiar with some facets of pulmonary heart disease
may gain insight into other aspects of this condition, whereas those unfamiliar with
this disorder may find this work useful as a general reference or as a resource to
address a specific question. Since there are few incontrovertible facts concerning
the approach to patients with pulmonary heart disease, emphasis has been placed
on general principles and guidelines rather than dogmatic recommendations.
xiii