Chronic Pulmonary heart disease
1.Definition
It is directly caused by chronic alterations in
pulmonary circulation or chronic chest diseases
that lead to pulmonary arterial hypertension,right
ventricular enlargement,even right heart failure,
2.Etiology
? A,Bronchial and pulmonary disorders,
chronic bronchitis complicated with COPD,
80－ 90%
asthma,bronchiectasis,tuberculosis,silicosis,
chronic interstitial lung disease
? B,Disorders of chest movement:（ rare）
abnormality,adhesion,vertebral tuberculosis、
rhumatoid spondylitis 。
2.Etiology
? C,Disorders of nerve and muscle
Poliomyelitis
disorders of motor-nerve center
? D,Disorders of pulmonary vessels
Hypersensitve granuloma ?
embolism of pulmonary artery
E,pulmonary arterial hypertension of
unknown cause
3.Pathology
? 1),main primary disorders of lung
chronic bronchitis and emphysema
? 2),changes of pulmonary vessels
A,the wall of pulmonary vessels
thickening,narrowing,or obliterative
B,capillary bed of alveolar wall
damaged,decreased
C,vascular bed of lung
compressed to be irregular
3.Pathology
? 3),changes of the heart
increased heart weight
hypertrophy of right ventricle
enlargement of right ventricle
4,Pathophysiology
and pathogenesis
A,pulmonary arterial hypertension
? 1),organic changes of pulmonary vessels
a,thickening of the vessels
b,deterioration of emphysema
c,Decreased capillary bed:>70%
? 2),functional changes of pulmonary vessels
factors of body fluid,tissue and nerve
? 3),remodeling of pulmonary vessels
vasoconstriction of vessels
hypertrophy of smooth muscle cell
? 4),increased blood volume and increased blood
viscosity
hypoxia? RBC ? ? blood viscosity ?
? resistance of blood flow ?
? Load of right ventricle ? and
hypertrophy of right ventricle
early stage,compensated
acute exacerbation,incompetency
cardiac output ?
B,Changes of right heart function
C,Impairment of the other
important organs
? Brain,liver,kidney
? digestive canal,et al
5.Clinic findings
? 1).compensated stage(include remittent stage)
signs,cough,sputum,wheeze,exertional dyspnea,
edema of low limb,exercise intolerance
physical examination
decreased breath sounds,rhonchi or moist rales
distance of the cardiac sound
P2>A2
the upper border of the liver ?
? 2).incompensated stage(include acute exacerbation)
respiratory failure ( induced by infection)
heart failure
6,Complications
? 1),pulmonary encephalopathy,main cause of
death
? 2),imbalance of acid and alkaline,disturbance
of electrolytes
? 3),arrhythmia
? 4),shock,infection,blood loss,cardiac
? 5),digestive bleeding
? 6),DIC
7,Laboratory findings and other
examinations
? a,Chest X-ray
the sign of pulmonary arterial
hypertension
the width of right-inferior pulmonary
artery>15mm
extruding of pulmonary artery segment
enlargement of right ventricle
? b.EKG
hypertrophy of right ventricle
Pulmonary P wave
Rv1+Sv5>1.05mV
V1,2,3 lead,Qs,V5 R/S<1
? c.Vectorcardiogram
Enlargement of right atrium and right
ventricle
? d.Echocardiogram
Inner diameter of outflow duct of right
ventricle >30mm
Inner diameter of right ventricle >20mm
Inner diameter of pulmonary
artery,increased
? e.blood gas analysis
PaCO2 ?,PaO2 ?,HCO3 ?,AB ?,
PH normal or ?,?
? f,blood test
RBC?,Hb ?,blood viscosity ?
WBC ?,P ?
K+,Na+,Cl-,Ca++,Mg++
8.Diagnosis
1,chronic bronchitis,emphysema,disorders of
chest and lung,disorders of pulmonary vessels,
et al
?pulmonary arterial hypertension,
right heart failure
2,corresponding symptoms and signs,X-ray,
EKG,lung function test
9.Differential diagnosis
1).coronary heart diseases
angina pectoris,myocardial infarction,
hypertension,hyperlipidemia,diabetes,
EKG,hypertrophy of left ventricle
2).rheumatic valvular heart diseases
Rheumatic arthritis,
mitral and aortic valvular disorders
3).primary cardiomyopathies
enlargement of the whole heart
without chronic respiratory history and pulmonary
arterial hypertension
10.Treatment
A,control infection
select effective antibiotics
B,free the airway,treat hypoxia and
hypercapnia
C,control heart failure
control heart failure
? 1) Diuretics,mild diuretics,avoid low K+ and
low Cl-
? 2) Digitalis,small dosage(1/2-2/3dose),
fast excretion and onset
? 3)vasodilators:decrease pulmonary artery
pressure,Ca++blocker
? 4)control arrhythmia
? 5)strengthen nursing
? 6)remittent stage
relieve the induced factors,exercise,
Chinese medicine,et al,
11.Prognosis
lung function ?
worsening prognosis
mortality rate,10-15%,