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(Circulation. 1995;92:622-631.)
© 1995 American Heart Association, Inc.

Articles

Vulnerability of Pulmonary Capillaries in Heart Disease

John B. West, MD, PhD, DSc; Odile Mathieu-Costello, PhD

From the Department of Medicine, University of California San Diego (La Jolla).

Address correspondence to John B. West, MD, PhD, UCSD Department of Medicine 0623-A, 9500 Gilman Dr, La Jolla, CA 92093-0623.

Abstract The pulmonary blood-gas barrier presents a dilemma. It must be extremely thin for efficient gas exchange. However, it also needs to be immensely strong because the stresses in the pulmonary capillary wall become extremely high when the capillary pressure rises. Stress failure of the capillaries occurs in several pathological conditions. It causes high-permeability edema as in neurogenic pulmonary edema or high-altitude pulmonary edema; alveolar hemorrhage, which occurs in all galloping racehorses; or a combination of the two as in severe congestive heart failure. The vulnerability of the capillary wall to increased mechanical stress has not previously been sufficiently appreciated.

Key Words: edema • hemorrhage • heart failure • pulmonary heart disease • blood pressure

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