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KMID : 0383819590060010046
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Tuberculosis and Respiratory Diseases
1959 Volume.6 No. 1 p.46 ~ p.56
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The Electrocardiographic Changes, Particularly of Cor Pulmonale in Far Advanced Pulmonary Tuberculosis and Thoracic Surgery
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이효근(李孝根)/HYO KEUN LEE
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Abstract
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The term "pulmonary heart disease," usually considered to be synonymous with "cor
pulmonale" and "heart-lung disease," refers to right strain or hypertrophy with or
without failure as a consequence of pulmonary hypertension due to increased resistance
to blood flow within the pulmonary circuit.
In pulmonary tuberculosis, the gradual decrease in the pulmonary vascular bed due to
fibrosis, emphysema, or both, is the major factor in the development of increased
pulmonary artery resistance with its sequelae of pulmonary hypertension and right
ventricular hypertrophy. Impaired ventilatory function with resultant anoxia,
hypervolemia, and polycythemia probable contributes to this syndrome when pulmonary
fibrosis and emphysema are severe. Chronic anoxia may cause increased pulmonary
artery pressure Increased blood volume in an already reduced pulmonary vascular bed
comtributes to the development of pulmonary hypertension. Erythrocytosis, not always
present, increases blood viscoisity, there by increasing resistance to blood flow and
elevating pulmonary artery pressure. Extensive destruction of lung parenchyma may
inerfere with the pulmonary blood flow. Marked retractive changes or marked restriction
of one or both lungs by a pleural membrane may be factors in the development of
chronic cor pulmonale.
Thoracic surgery in pulmonary tuberculosis such as thoracoplasty or pneumonectomy
may embarrass the heart mechanically by pressure or torsion of the pulmonary vessels
or may cause impaired respiratory function, displacement or distention of the remaining
lung, which also contributes to the development of pulmonary hypertension.
This study deals largely with the electrocardiographic changes of right ventricular
hypertrophy in far advanced pulmonary tuberculosis and surgically treated pulmonary
tuberculosis.
One hundred and eleven unselected pulmonary tuberculosis patients, 56 cases of far
advanced long-standing disease and 55 cases in which thoracic surgery had been done,
were studied.
The electrocardiographic evidence of right ventricular hypertrophy was found to be
8.9percent in the non-surgical group, and 1.8percent in the thoracic surgery group.
Postoperative changes of the electric axis, electrical position of the heart, transitional
zone of the QRS complex, T waves, and P waves were related to a shift or rotation of
the heart and the mediastinum following surgery.
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