Cor pulmonale: a semantic consideration, with brief notes on diagnosis and treatment.

There is a conspicuous lack of agreement as to what lesions or clinical conditions should be included in the term “cor pulmonale.” Varied and conflicting views prevail throughout the literature, current and old)’8 Historically, the first use of the term cor pulmonale appears to #{149}have been in 1931 by Paul Whmte;i prior to this time “emphysema heart” was in common use. In the first edition of his textbook on heart disease White speaks of “pulmonary heart disease or cor pulmonale” and indicates prefference for the latter term. Twenty years later (4th edition)2 he continues to speak of “cor pulmonale or pulmonary heart disease,” using these terms as synonyms. In discussing the etiology of cor pulmonale he stresses “chronically increased resistance in the pulmonary circulation due commonly to narrowing of the arterioles and capillary bed,” but specifically excludes from this category resistance due to “left heart failure, mitral stenosis, or congenital heart disease.” In a recent review Fishman and Richards3 define cor pulmonale as “a heart which manifests dilatation, hypertrophy, or failure secondary to intrinsic disease of the lungs ;“ they specifically exclude from this definition “right ventricular hypertrophy, dilatation or failure secondary to disease of the heart, e.g. mitral stenosis.” On the other hand, Griffith4 includes right ventricular changes of mitral stenosis in the general category of cor pulmonale; he makes a distinction between “primary” cor pulmonale in which “pulmonary hypertension is the basic lesion” and “secondary” cor pulmonale “in which the basic lesion lies not in the pulmonary circuit but beyond, in the left side of the heart.” Oram5 broadily defines cor pulmonale as “hypertrophy and eventual failure of the right ventricle resulting from disease of the lungs, or disorder of the pulmonary circulation.” However, when he lists the specific lesions causing disorders of the pulmonary circulation he omits all congenital cardiac lesions. Mack and Snider6 define cor pulmonale as “right ventricular hypertrophy resulting from disease involving the lung and pulmonary circulation” but exclude from this category “other causes of right ventricular hypertrophy, such as mitral stenosis, congenital heart disease, and left ventricular failure.” Hecht,7 however, includes pulmonary valvular stenosis as well as “pure mitral stenosis” in which “secondary vascular changes (in the pulmonary bed) develop, apparently the result of long-standing pulmonary vascular congestion, high capillary and arte-