THE LUNG VOLUME IN HEART DISEASE.

The lung volumes in a group of individuals suffering from chronic cardiac disease have been studied by a method which is applicable to patients suffering from dyspnea. In a number of instances the same patients were investigated during various stages of decompensation and compensation. The values found have been compared with those determined in a group of normal subjects. Lung volumes have been considered from three points of view: (1) relative lung volumes or subdivisions of total lung volume expressed as percentage of total lung volume; (2) the absolute lung volumes of patients with heart disease have been compared with lung volumes calculated for normal individuals having similar surface areas or chest measurements; and (3) in individual cases absolute lung volumes have been measured in various stages of compensation and decompensation. (1) In patients with heart disease it has been observed that the vital capacity forms a portion of the total lung volume relatively smaller than in normal individuals, and that the mid-capacity and residual air form relatively larger portions. When the patient progresses from the compensated to the decompensated state these changes become more pronounced. (2) When the absolute lung volumes determined for patients are compared with volumes of the same sort, as calculated for normal individuals of the same surface areas and chest measurements, the following differences are found. The vital capacities are always smaller in the patients and the volumes of residual air are always larger. There is a tendency for middle capacity and total capacity to be smaller, though, when the patients are in a compensated state, these volumes may approximate normal. (3) When decompensation occurs the absolute lung volumes undergo changes as follows: (a) vital capacity, mid-capacity, and total capacity decrease in volume; and (b) the residual air may either increase or decrease according to the severity of the state of decompensation. The significance of these changes has been discussed and an explanation offered for the occurrence of a residual air of normal volume in patients with heart disease. It results from a combination of two tendencies working in opposite directions: one to increase the residual air-stiffness of the lungs (Lungenstarre); the other to decrease it-distended capillaries (Lungenschwellung), edema, round cell infiltration.