Most of the modern textbooks of medicine state that emphysema leads to heart failure. This is presumed to be due to stretching and later, as the lungs distend, to rupture of the pulmonary capillaries in the alveolar walls. It is thought that the reduction in the vascular bed thereby throws on the right side of the heart an extra load which leads to hypertrophy and dilatation and subsequent right-sided heart failure. With this reasoning, the dyspnea, cyanosis and dependent edema so often seen with advanced emphysema are explained as the results of cardiac decompensation. Hoover,1 however, found little evidence of pure rightsided failure. He believed that both the right and left ventricles are affected and attributed their failure to the effects of anoxemia on the heart muscle.
Alexander, Luten and Kountz2 reported fifty cases of long standing bronchial asthma, most of which were complicated by pronounced emphysema. In
KOUNTZ WB, ALEXANDER HL, DOWELL D. EMPHYSEMA SIMULATING CARDIAC DECOMPENSATION. JAMA. 1929;93(18):1369–1371. doi:10.1001/jama.1929.02710180019007
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