The heart in the pneumoconiosis of coalminers.

The pneumoconiosis of coalminers is a primary disorder of the lungs that can cause pulmonary heart disease, a condition also called cor pulmonale. The occurrence of right heart changes in pneumoconiosis was noted by Pancoast and Pendergrass (1931). Dyson (1933 and 1934) described the radiological recognition of heart disease in pneumoconiosis, and in a review of 127 cases found 18 with evidence of pulmonary heart disease. Discussing the pathology of pneumoconiosis, Jaffe (1934) concluded that the replacement of large parts of the lungs by poorly vascularized scar tissue, and the occurrence of obliterative changes in the branches of the pulmonary artery, interfered greatly with the pulmonary circulation. Right ventricular hypertrophy followed and failure of the right heart was a common cause of death in advanced pneumoconiosis. Coggins et al. (1938) found that hypertrophy of the right ventricle was a common finding in the autopsy records of 102 proven cases of pneumoconiosis. Other studies of the pathology of pulmonary heart disease record right ventricular hypertrophy with anthraco-silicosis (Scott and Garvin, 1941; Spain and Handler, 1946). In the South Wales anthracite coalfield, Gooding (1946) has reviewed a series of 227 post-mortem examinations on miners certified as having pneumoconiosis; 37 per cent are described as having died from cardiac failure, usually right-sided. Emphysema is a common cause of pulmonary heart failure. Gough (1940, 1946, 1947) has described the occurrence of emphysema in coalminers' pneumoconiosis and has differentiated the focal emphysema from the bullous emphysema that occurs in later stages of the disease. Geever (1947) has confirmed the occurrence of pulmonary vascular changes. The clinical course of a pulmonary disease may be divided into two phases, the pulmonary phase and the cardiac phase (Brill, 1939). The clinical features of the cardiac phase in pneumoconiosis have been described by several writers, some of whom have indicated the difficulties in assessing the 'degree of involvement of the right heart (Coggins et al., 1938; Giering and Charr, 1939; and Ketterer, 1941). McMichael and Sharpey Schafer (1944) have drawn attention to the fact that cases of cor pulmonale may have a high cardiac output. They have found this in patients with emphysema, gross venous congestion, and a low arterial oxygen saturation. In the terminal stages the left heart may fail and pulmonary oedema occur. The pneumoconiosis of coalminers has been presented in detail by Fletcher (1948).