PHYSIOLOGICAL EFFECTS OF PULMONARY HYPERTENSION ON CARDIAC FUNCTION



The right and left sides of the heart are func­tionally integrated by their anatomical contiguity. There is continuity between their free walls, they share a common wall (the intraventricular sep­tum), and they are covered by the pericardium. When pulmonary vascular resistance is normal, the right ventricle serves as a capacitance cham­ber, performing only minimal contractile work. It compensates ineffectually for acute rises in pul­monary artery pressure, and acutely it can only generate a mean pressure of 40 mm Hg. Acute el­evations of right ventricular pressures also inter­fere with left ventricular performance, presum­ably owing to a shift in the intraventricular septum to the left. Chronic elevations of pulmo­nary artery pressure cause gradual hypertrophy of the right ventricle, which eventually allows it to generate pressures equal to those in the left ven­tricle.