[Current status of the problem of chronic cor pulmonale]

Studies of great number of patients with chronic nonspecific pulmonary disease suggest that high levels of pulmonary hypertension are only observed in cases of pulmonary-arterial thromboembolism and primary pulmonary hypertension. In other pulmonary diseases, the significance of pulmonary hypertension seems to be overestimated, as blood pressure in the pulmonary circulation network has values, indicative of the absence of gross morphologic changes of the vascular bed of the lungs. The available indirect methods for the diagnosis of pulmonary hypertension in chronic nonspecific pulmonary disease patients with rather small blood pressure in the pulmonary circulation network are shown to be of little value. Large functional reserves of the right cardiac ventricle which make it possible to cope with a sudden pressure overstrain (to say nothing of the slowly augmenting one) are pointed out. It follows therefore that either as yet unknown factors contribute to the pathogenesis of chronic pulmonary heart decompensation, or there is virtually no decompensation, while the demonstrated clinical symptoms of systemic circulatory congestion are of extracardiac origin. Various aspects of the assessment of the role of pulmonary hypertension and clinical symptoms of decompensated pulmonary heart will be discussed in the next communication.