Coronary arterial disease and arrhythmias in chronic obstructive pulmonary disease.
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Biomedical subjects
Publications and source records attributed to R G Kachel.
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The presence or absence of left ventricular dysfunction in chronic obstructive pulmonary disease has been debated for decades. I have reviewed the following evidence pertaining to this topic: (1) left ventricular pathologic abnormalities; (2) the methods used to determine left ventricular performance; (3) specific abnormalities of left ventricular function as revealed by systolic time intervals, left ventricular end-diastolic pressure, ejection fraction, isovolumic indices, and left ventricular function curves; and (4) pertinent experimental data. The bulk of the evidence indicates that the clinical symtoms of left-sided failure are unreliable in those with obstructive disease of the airways and that the great majority of patients have normal left ventricular function, once other causes are excluded. A small group of patients have some abnormalities in left ventricular performance, but these have not been clinically significant. The ultimate importance of such abnormalities awaits future investigation.
The clinical course of a woman with metastatic reticulum cell sarcoma and intractable lactic acidosis is described. Although her illness was dominated by a myelopathy, she developed severe lactic acidosis which could not be related to decreased tissue oxygen delivery. Necropsy showed extensive hepatic replacement with tumor and widespread disease. This and other possible pathogenetic factors causing lactic acidosis are discussed.