Chronic right heart failure: pulmonary considerations.

Right ventricular failure is a frequent companion of chronic pulmonary disease, particularly that associated with chronic desaturation. Increases in right ventricular after-load will occur as the result of a number of mechanisms, many of which are present in the face of altered pulmonary physiology. To assess the role of pulmonary disease in the development of chronic right failure, one needs a knowledge of the physiologic effects of the respiratory process in each individual. Is the physiologic profile appropriate to be associated with cor pulmonale? Advances in understanding control of breathing, sleep-disordered breathing, and exercise contribute to clarifying the clinical picture of many patients with chronic right heart failure. In these patients, changes in afterload continue to be the central predominant problem.