The mechanism and incidence of cardiovascular changes in Paget's disease (osteitis deformans); a critical review of the literature with case studies.

Although abundant evidence of concomitant cardiovascular disease is scattered throughout the literature on osteitis deformans, appreciation of the etiologic relationship between the two diseases has been lacking. This paper shows that cardiovascular disease accompanying extensive osteitis deformans may result from: (1) excessive demand on the heart from increased vascularity of affected bones; (2) the influence of concomitant arteriosclerosis apparently exceeding the formal for the age concerned; (3) characteristic thoracic spine deformities which compromise cardio-respiratory function, and (4) hypertension. Fifty-four cases are presented. The incidence of cardio-vascular disease exceeds that in the general population of the same age and corresponds with the extent of skeletal involvement. M ANY PHYSICIANS conversant with the osseous characteristics of Paget's disease are not well acquainted with concomitant changes in the heart and blood vessels which occur in the same disease. Incontrovertible evidence of such changes is scattered throughout the voluminous literature on osteitis deformans that has accumulated since Sir James Paget's original paper, but to date little attempt has been made to correlate these various findings and opinions, nor has any extensive study on the incidence of such changes been made. We have, therefore, reviewed the literature on Paget's disease with particular reference to the nature and incidence of the attendant cardiovascular changes, and presented a series of consecutive cases in which studies of heart size and electrocardiographic examinations have been made in an attempt to correlate previous observations and establish the incidence of related cardiovascular disease in osteitis deformans.