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Q J Med 1966; 35: 261-275
© 1966 Association of Physicians

research-article

GENERAL ALVEOLAR HYPOVENTILATION: A SYNDROME OF RESPIRATORY AND CARDIAC FAILURE IN PATIENTS WITH NORMAL LUNGS

A. P. FISHMAN2, R. M. GOLDRING and G. M. TURINO

Department of Medicine, Columbia University College of Physicians and Surgeons New York

Received 10 June 1965 Chronic alveolar hypoventilation has been considered in terms of its pathogenesis. Distinction has been made between general alveolar hypoventilation, which arises from failure of the ventilatory apparatus, and net alveolar hypoventilation which is secondary to bronchopulmonary disease. Examples are presented to ifiustrate the pathogenesis of general alveolar hypoventilation in various disorders of the ventilatory apparatus. The common end-points for all of these are arterial hypoxaemia and hypercapnia; these abnormalities in the blood gases are responsible for the cardiorespiratory failure of chronic alveolar hypoventilation. However, the clinical expression of these abnormal blood gases is modified by the pathogenetic background: in failure of the respiratory centre, the consequences of arterial hypoxaemia and hypercapnia are manifest in the purest forms, free of the complications of abnormal lungs or mechanics of breathing; in severe kyphoscoliosis, the compressed distorted lung restricts the pulmonary hypertension and cor pulmonale; in obesity, the hypermetabolic and hypervolemic states provide a background of left ventricular, as well as right ventricular overload, for the consequences of arterial hypoxaemia and hypercapnia. The clinical importance of recognizing the syndrome of general alveolar hypoventilation lies in its reversibility following adequate relief of the hypoxaemia and hypercapnia.

2 At present Fellow of the Commonwealth Fund at the Nuffleld Institute for Medical Research, Oxford, England.


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