A clinical consideration of cor pulmonale.

Definition T HE term cor pulmonale is genierally used to define the cardiac complications of certain forms of lung disease. From knowledge gathered in the recent past, it is apparent that a number of disease processes that attack pulmonary funetioni in a variety of ways can produce circulatory embarrassment. The mechanisms by which they do so may be fundamentally different and indeed the lungs themselves need not be directly inivolved. The terms cor pulmonale or pulmonary heart disease are far froin ideal, since they imply cardiac disorders secondary only to pulmonary parenehymal disease, whereas the name should be more inclusive and encompass cardiac abniormalities stemming fromii any form of pulmonary dysfunetion. It is therefore suggested that the name cor pulmonale always be coupled with the respolisible etiologic agent; for exanlple, cor pulmonlale due to chronic obstructive pulmonary emphysema, due to multiple pulmonary emboli (acute or chronic), due to exogenous obesity, due to berylliosis, due to poliomyelitis, etc. Inasmuch as mnany of the circulatory abnormalities and the cardiac enlargement itself may be reversible in some of these instances, it seems wise to eliminate the termns acute, subacute, or chronic as applied to these circulatory complicatioiis and use them solely in relationship) to the respiratory illness. Cor pulmonale would then be diagnosed only when evidences of right ventricular enlargement or failure are, or have been, shown to be present. Physiologic complications, such as anoxia, hyper-