Cor Pulmonale in Coal-Worker's Pneumoconiosis

Wells, A. L.

doi:10.1136/hrt.16.1.74

Cited by 21 publications

(11 citation statements)

References 11 publications

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“…Although McKeown (1952) found no hyperplastic changes in the small vessels in the majority of 39 cases of emphysema with cor pulmonale, the changes she observed in the remainder were similar to those in Case 2. The endarteritis affecting muscular arteries in the larger dust foci resemble those described by Wells (1954a) in areas of progressive massive pneumoconiotic fibrosis. Cor pulmonale develops commonly in progressive fibrosis but comparatively rarely in the simple type of miners' pneumoconiosis (Wells, 1954b).…”

supporting

confidence: 55%

Pulmonary Haemosiderosis Associated with Bronchiectasis

Cameron¹

1956

Thorax

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supporting

confidence: 55%

Pulmonary Haemosiderosis Associated with Bronchiectasis

Cameron¹

1956

Thorax

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“…Coal workers with simple pneumoconiosis, however, can have disease of the pulmonary vessels if there is associated chronic pulmonary disease, particularly chronic bronchitis, or if the pulmonary lesion is produced by silica rather than by coal (4,6). Silicosis can be present if the miner has worked as a motorman or roofbolter and therefore has been exposed to silica dust (15).…”

Section: Discussionmentioning

confidence: 98%

“…Right ventricular hypertrophy occurs in subjects with the complicated form of coal workers pneumoconiosis, but it is seldom found in those with the simple form of the disease in tbe absence of concomitant tuberculosis or chronic obstructive airway disease (1)(2)(3)(4). Nevertheless, some investigators have suggested that simple pneumoconiosis not infrequently leads to significant disease of the pulmonary vascular bed and that this can be detected in life on the basis of characteristic (Received in revised form November 19, 1970) 1 From the Appalachian Laboratory for Occupational Respiratory Diseases, Bureau of Occupational Safety and Health, U. S. Public Health Service; and the Department of Medicine, West Virginia University School of Medicine, Morgantown, West Virginia 26505. physiologic abnormalities (5).…”

Section: Introductionmentioning

confidence: 99%

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Pulmonary Hemodynamics in Symptomatic Coal Miners¹

Lapp¹,

Seaton²,

Kaplan³

et al. 1971

Am Rev Respir Dis

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____________________________________________________ _Forty-seven coal miners, selected because they were symptomatic, underwent studies of pulmonary hemodynamics at rest and during exercise_ They were divided into two groups depending on the absence or presence of airway obstruction. Of the 23 in the group without airway obstruction, one had a high mean pulmonary artery pressure at rest and another 3 showed increase of this pressure during exercise. All 4 had the pinpoint type of simple pneumoconiosis. Of the subjects with obstruction, 7 of 24 ·had pulmonary arterial hypertension that could be accounted for by airway obstruction or complicated pneumoconiosis, whereas one with less severe obstruction had pinpoint opacities on his chest radiograph.Abnormalities of alveolar-arterial oxygen gradient, arterial oxygen tension, and dead space ventilation were common in both groups, but were only significantly related to pulmonary artery pressure in the group with obstruction. These results indicate that pulmonary arterial hypertension can occur in the pinpoint type of simple coal workers pneumoconiosis in the absence of obstructive airway disease, although its infrequency in this selected group of symptomatic miners suggests that it is very uncommon.

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“…In some cases of silicosis the predominantly perivascular location of the nodules was the main cause of the pulmonary hypertension and chronic cor pulmonale. However, in most cases of silicosis when severe respiratory insufficiency and chronic cor pulmonale occur, there is complicating severe diffuse obstructive emphysema.28 30,33 The latter is chiefly responsible for the development of chronic cor pulmonale. In some silicotic patients, thrombosis of a major branch of the pulmonary artery occurs and contributes to the reduction in the pulmonary vascular bed.30 C. Pathogenesis of Type I Chronic Cor Pulmonale The development of hypertrophy of the right ventricle in chronic diffuse obstructive emphysema is a result of right heart strain.…”

Section: Combinations Of Types I and Iimentioning

confidence: 99%

Respiratory Insufficiency and Chronic Cor Pulmonale

Mack¹,

Snider²

1956

Circulation

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Because of newer technics of treatment, a small but ever increasing number of patients with chronic pulmonary disease are surviving long enough to develop chronic cor pulmonale. An attempt has been made to correlate the newer knowledge of aberrations of cardiocirculatory and respiratory physiology in chronic pulmonary disease. Respiratory insufficiency may be due to varying proportions to the following: (1) ventilatory dysfunction or impairment of the ability to move air into or out of the lungs; this may be of two types: (a) obstructive, due primarily to airway narrowing and (b) restrictive, due to disordered function of the thoracic bellows or diminished pulmonary distensibility; (2) unequal distribution of inspired air to the alveoli (intrapulmonary mixing); (3) uneven perfusion or distribution of capillary blood flow; (4) impaired diffusion or transfer of oxygen across the alveolar capillary barrier and (5) impaired cleansing of the lung. The same abnormal physiologic change may result from pathologic conditions which differ widely in etiology; furthermore, a particular disease may give rise to widely differing functional patterns. The types of pulmonary disease causing chronic cor pulmonale may be divided into two main categories: (1) Type I, pulmonary diseases associated with chronic diffuse obstructive emphysema. (2) Type II, pulmonary diseases in which the pathologic process tends to be localized in or about the pulmonary vessels. In some instances, a case belongs mainly in one category but may demonstrate some features of the other. The strain on the right ventricle is a result of: (1) increased resistance to pulmonary blood flow and (2) increased cardiac output (when present). Increased resistance to pulmonary flow may be due to: (a) reduction in caliber and distensibility of the pulmonary vascular bed which may be structural or related to hypoxia, (b) polycythemia and (c) intrapulmonary vascular shunts. Respiratory insufficiency may be suspected from the history. Physical and roentgenologic examinations may be confirmatory, but pulmonary function tests are necessary for a precise evaluation of the functional abnormalities. The recording of a physiologic, as well as a pathologic diagnosis, is a useful practice in the individual case. The presence of right ventricular enlargement can only be detected clinically when the chronic cor pulmonale is moderately advanced. However, clinical and roentgenologie evidence of pulmonary hypertension in chronic pulmonary disease indicates that right ventricular hypertrophy is probably present. The electrocardiogram may be helpful even in the absence of a definite right heart strain pattern since the electric position of the heart is often suggestive. Cardiac catheterization provides the best method for the early detection of pulmonary hypertension. The treatment of chronic cor pulmonale is much more hopeful today than in the past. It is most satisfactory when cor pulmonale is due to pulmonary disease of type I. Intensive therapy of the bronchopulmonary disease is as important as specific cardiac measures. The objectives of therapy are to combat infection, produce an adequate airway and improve effective alveolar ventilation. This may partially reverse many of the pathologic changes in the lung which are responsible for hypoxia and the anatomic reduction in the pulmonary vascular bed.

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Cor Pulmonale in Coal-Worker's Pneumoconiosis

Cited by 21 publications

References 11 publications

Pulmonary Haemosiderosis Associated with Bronchiectasis

Pulmonary Haemosiderosis Associated with Bronchiectasis

Pulmonary Hemodynamics in Symptomatic Coal Miners¹

Respiratory Insufficiency and Chronic Cor Pulmonale

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Cor Pulmonale in Coal-Worker's Pneumoconiosis

Cited by 21 publications

References 11 publications

Pulmonary Haemosiderosis Associated with Bronchiectasis

Pulmonary Haemosiderosis Associated with Bronchiectasis

Pulmonary Hemodynamics in Symptomatic Coal Miners1

Respiratory Insufficiency and Chronic Cor Pulmonale

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Pulmonary Hemodynamics in Symptomatic Coal Miners¹