What is a major pathophysiological mechanism of significantly impaired cardiovascular and pulmonary function in a very heavy (obese)individual?

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In very heavy individuals,cardiovascular and pulmonary function can be significantly impaired,resulting in hypoxemia and cardiovascular and pulmonary failure.The major pathophysiological mechanisms behind this include significant alveolar hypoventilation,reactive hypoxic pulmonary vasoconstriction,increased pulmonary vascular resistance,myocardial hypertrophy,increased right ventricular work,altered position of the thoracic structures,abnormal compression of the heart,lungs,and mediastinal structures,abnormal position of the heart,cardiomegaly,increased intraabdominal pressure,elevated hemidiaphragms with resulting pressure on the underside of the diaphragm,impaired cough effectiveness,impaired mucociliary transport,mucous obstruction of airways,airway narrowing,bronchospasm,impaired mechanical efficiency of diaphragmatic excursion,and impaired respiratory mechanics and breathing efficiency.

What Is a Major Pathophysiological Mechanism of Significantly Impaired Cardiovascular