Congestive Heart Failure

Pulmonary Oedema

“…Convincing evidence scarcely exists, and I would put forward ,a plea for a re-examination of the problem. Pulmonary Oedema resulting from Circulatory Failure Without doubt pulmonary oedema is met with most often in association with some degree of circulatory failure, and standing high in the list of pathological favourites are hypertensive disease, with or without chronic nephritis, advanced mitral stenosis, and obstruction of the coronary vessels (see reviews by AHess, 1932;Frugoni, 1930;Parker and Weiss, 1936;Harrison et al, 1934;Weiss, 1942). Our necropsy records disclosed ,severe lung oedema in 86% of 94 hypertensive cases, in 68% of 66 cases of complete coronary obstruction, and in 65% of 84 cases of mitral stenosis, an experience which is in agreement with the general run of necropsy findings.…”

“…I am forced to the opinion that some other factor may be necessary in addition to a higher head of filtration pressure within the capillaries in order to precipitate an attack of pulmonary oedema.. What this is I cannot say, but I feel sure it may act through modifying the permeability of the vessels. Perhaps a moderate degree of anoxia, which alone will not give oedema, may suffice to tip the balance (Warren and Drinker, 1942): a dyspnoeic seizure with a further increase in pulmonary congestion (Fraser et al, 1928;Harrison et al, 1934) and a lowering of subatmospheric intrapleural pressure (Prinzmetal and Kountz, 1935), an attack of bronchitis, or a moderate depletion of the plasma protein leading to diminution of colloidal osmotic pressure of the plasma might well qualify for this category of contributory factors.…”