This Article Full Text Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by West, J. B. Articles by Mathieu-Costello, O. Search for Related Content PubMed PubMed Citation Articles by West, J. B. Articles by Mathieu-Costello, O. Pubmed/NCBI databases Medline Plus Health Information Heart Diseases

(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

This article has been cited by other articles:

				Z. S. Azzam, Y. Adir, L. Welch, J. Chen, J. Winaver, P. Factor, N. Krivoy, A. Hoffman, J. I. Sznajder, and Z. Abassi Alveolar fluid reabsorption is increased in rats with compensated heart failure Am J Physiol Lung Cell Mol Physiol, November 1, 2006; 291(5): L1094 - L1100. [Abstract] [Full Text] [PDF]

				A. Patrawalla, D. Addrizzo-Harris, and R. Condos PULMONARY HYPERTENSION (PHTN) AND ALVEOLAR HEMORRHAGE IN PREGNANCY: A CASE OF MATERNAL PATENT DUCTUS ARTERIOSUS (PDA) Chest Meeting Abstracts, October 1, 2005; 128(4): 434S - 434S. [Abstract] [Full Text] [PDF]

				C. G. De Pasquale, L. F. Arnolda, I. R. Doyle, P. E. Aylward, D. P. Chew, and A. D. Bersten Plasma Surfactant Protein-B: A Novel Biomarker in Chronic Heart Failure Circulation, August 31, 2004; 110(9): 1091 - 1096. [Abstract] [Full Text] [PDF]

				B. K. Gehlbach and E. Geppert The Pulmonary Manifestations of Left Heart Failure Chest, February 1, 2004; 125(2): 669 - 682. [Abstract] [Full Text] [PDF]

				M. Guazzi Alveolar-Capillary Membrane Dysfunction in Heart Failure: Evidence of a Pathophysiologic Role Chest, September 1, 2003; 124(3): 1090 - 1102. [Abstract] [Full Text] [PDF]

				C. G. De Pasquale, A. D. Bersten, I. R. Doyle, P. E. Aylward, and L. F. Arnolda Infarct-induced chronic heart failure increases bidirectional protein movement across the alveolocapillary barrier Am J Physiol Heart Circ Physiol, June 1, 2003; 284(6): H2136 - H2145. [Abstract] [Full Text] [PDF]

				Z. S. Azzam, V. Dumasius, F. J. Saldias, Y. Adir, J. I. Sznajder, and P. Factor Na,K-ATPase Overexpression Improves Alveolar Fluid Clearance in a Rat Model of Elevated Left Atrial Pressure Circulation, January 29, 2002; 105(4): 497 - 501. [Abstract] [Full Text] [PDF]

				J. B. Slade Jr, T. Hattori, C. S. Ray, A. A. Bove, and P. Cianci Pulmonary Edema Associated With Scuba Diving : Case Reports and Review Chest, November 1, 2001; 120(5): 1686 - 1694. [Abstract] [Full Text] [PDF]

				Z. S. Azzam, F. J. Saldias, A. Comellas, K. M. Ridge, D. H. Rutschman, and J. I. Sznajder Catecholamines increase lung edema clearance in rats with increased left atrial pressure J Appl Physiol, March 1, 2001; 90(3): 1088 - 1094. [Abstract] [Full Text] [PDF]

				P Faggiano, A D'Aloia, A Gualeni, and A Giordano Relative contribution of resting haemodynamic profile and lung function to exercise tolerance in male patients with chronic heart failure Heart, February 1, 2001; 85(2): 179 - 184. [Abstract] [Full Text]

				L. R. Johnson, J. L. Parker, and M. H. Laughlin Chronic exercise training improves ACh-induced vasorelaxation in pulmonary arteries of pigs J Appl Physiol, February 1, 2000; 88(2): 443 - 451. [Abstract] [Full Text] [PDF]

				T. Gluecker, P. Capasso, P. Schnyder, F. Gudinchet, M.-D. Schaller, J.-P. Revelly, R. Chiolero, P. Vock, and S. Wicky Clinical and Radiologic Features of Pulmonary Edema RadioGraphics, November 1, 1999; 19(6): 1507 - 1531. [Abstract] [Full Text] [PDF]

				L. H. Ketai Invited Commentary RadioGraphics, November 1, 1999; 19(6): 1532 - 1533. [Full Text] [PDF]

				D. R. Schwartz, A. Maroo, A. Malhotra, and H. Kesselman Negative Pressure Pulmonary Hemorrhage Chest, April 1, 1999; 115(4): 1194 - 1197. [Abstract] [Full Text] [PDF]