Study on the Clinical Criteria of Chronic Cor Pulmonale, Especially about the Indications and the Reasons
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The definition of chronic Cor pulmonale in W. H. O. report (1961) is based on right ventricular hypertrophy (RVH), or the definition of an anatomical change in heart, and it grades RVH according to both the thickness and weight of the right ventricle. That definition is therefore neither helpful to clinically diagnosis nor convenient for the evaluation of the extent and prognosis of the disease.Many recent studies have made it clear that such classification is anatomically and physiologically incomplete. For that reason, anatomical, physiological, and clinical studies were done coordinately on the advice of W. H. O. report, and these studies led us to make this new clinical criteria of chronic Cor pulmonale based on spirography, blood gases, and ECG.Our criteria are very practical and useful for the prognosis.A) The presence of chronic obstructive lung disease.The diagnosis depends on the subjective symptomes and on the chest films. Similar clinical and physiological manifestations which may originate from congenital heart disease or left heart failure must be ruled out before the diagnosis is made.a) Obstructive ventilatory disturbance (irreversible more than 3 to 6 months)FEV1.0 less than 70%less than 55%b) Restrictive ventilatory disturbance (irreversible more than 3 to 6 months)%VC less than 80%less than 40%c) Mixed ventilatory disturbancea)+b)d) Impairment of diffusionDLCO decreasePaO2 decrease (rest and exercise)e) Pulmonary vascular disorders (Especially pulmonary embolism. Even when a)-d) are not seen, the course of the disorders must be carefully observed)pulmonary scincigram.B) The assessment of chronic Cor pulmonale (exclude cardiac cathetelization).1) MBC less than 40%(irreversible more than 3 to 6 months)2) PaO2 i) less than 70mmHgii) less than 55mmHg(irreversible more than 3 to 6 months)3) PaCO2 i) more than 47mmHgii) more than 60mmHg(irreversible more than 3 to 6 months)4) ECG RVH (W. H. O.)ST depression (in II, III, aVF, V) including flatt T. Master's test(±) (+)at rest (±) (+)5) The presense or the previous history of systolic trust, congestion, edema (increased venous pressure).Notes:a) Below than 2) ii) column in the table; highly supspected.Below than 3) ii) column in the table; definite.b) RVH (W. H. O.) in the ECG column include hemondynamic overload and or decompensation, apart from anatomical hypertrophy.c) In the case of pulmonary vascular disturbance, ECG is most important.d) In the case of acute Cor pulmonale too, this criteria of A) will be applied by cnanging the period.e) About the cases with complications (senile lung, senile heart, coronary sclerosis, hypertension, diabetes mellitus etc.) this criteria will not be applied perfectly.
- 社団法人 日本老年医学会の論文