Cor Pulmonale in Emphysema.

Thomas L. Petty, MD
Arch Intern Med. 1969;124(5):640. doi:10.1001/archinte.1969.00300210122025.
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Understanding the mechanisms of disease is often a basic goal of investigator and clinician alike. The pathogenesis of cor pulmonale in emphysema and related diseases is reactive pulmonary hypertension due to hypoxemia. The anatomic basis for this pulmonary hypertension (as explained by this monograph) is at the arteriolar level and involves the development of a "distinct muscular media" sandwiched between elastic laminae, as well as a longitudinally oriented muscle layer. The role of hypoxemia in pulmonary hypertension and cor pulmonale only comes forth during the final two chapters which turn out to be the essence of the book, the last 21 pages. Thus, one arrives at the meat of the monograph after wading through unnecessary descriptions of techniques for studying the lung, as well as lengthy derivations of formulas designed to estimate the amount of emphysema present. Actually, the semiquantitative estimate of emphysema from whole lung sections with the use


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