Portal de Periódicos da CAPES

PULMONARY HYPERTENSION

1940; BMJ; Volume: 2; Issue: 3 Linguagem: Inglês

10.1136/hrt.2.3.189

1468-201X

T. East,

Pulmonary Hypertension Research and Treatments

This title has been chosen deliberately, although it denotes something hypothetical, as indicating a possible cause of the facts hereafter described.These three cases were reported at the meeting of the Cardiac Society at Birmingham in 1939.The subsequent outbreak of war has made it impossible to survey the literature, so there are no references.I think, however, that the accurate presentation of the observations is the important thing.There can be no doubt that we are confronted with a curious and hitherto rare condition; its nature and causation will need further study, but the account of these three cases may be helpful and may draw attention to others. NOTES OF FIRST CASEA married woman of 31, with one child aged 6, was first seen in December 1936, complaining of dyspncea even on walking on the level.She also noticed palpitation, and had to sleep supported by three pillows, though there had been no dyspncea at night.These symptoms had been coming on gradually for two or three years.There was no history of rheumatic fever or any important illness.She was of medium build, with a flattish chest and a somewhat depressed lower end of the sternum.The lips were slightly cyanosed.There was no cedema, and the liver and external jugular veins were not engorged.The heart was enlarged (15 cm. in transverse diameter on screening).The electrocardio- gram in this case (Fig. IA), as in the others, indicated that the increase in size was in the right ventricle.Clinically, enlargement was obvious in the region of the pulmonary artery and conus arteriosus.Here one could detect definite systolic pulsation, a slight systolic murmur, a very loud pulmonary second sound, and an easily palpable closure of the pulmonary valves.Screen- ing showed the greatly enlarged pulmonary artery (Fig. 2A) and its branches seemed conspicuous, for there was a definite " hilar dance."The lungs were clear.The left auricle was not enlarged (Fig. 2B).The peripheral arteries were normal.There was slight polycythxmia; red cells 6-4-million,-hoemo- globin 126 per cent.There was no clubbing of the fingers.The Wassermann reaction was negative.B.P. 125/70.The enlargement of the right ventricle and of the pulmonary artery and its branches prompted a diagnosis of patent interauricular septum.