張斯為－肺心病

1、Chronic Pulmonary heart disease1.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.12.EtiologyA. Bronchial and pulmonary disorders： chronic b

2、ronchitis complicated with COPD: 8090% asthma, bronchiectasis, tuberculosis, silicosis, chronic interstitial lung diseaseB. Disorders of chest movement:（rare）abnormality, adhesion, vertebral tuberculosis、rhumatoid spondylitis 。2 2.EtiologyC. Disorders of nerve and musclePoliomyelitisdisorders of mot

3、or-nerve centerD. Disorders of pulmonary vessels Hypersensitve granuloma embolism of pulmonary arteryE. pulmonary arterial hypertension of unknown cause33.Pathology1). main primary disorders of lung chronic bronchitis and emphysema2). changes of pulmonary vessels A. the wall of pulmonary vessels thi

4、ckening, narrowing, or obliterative B. capillary bed of alveolar wall damaged , decreased C. vascular bed of lung compressed to be irregular4 3.Pathology3). changes of the heart increased heart weight hypertrophy of right ventricle enlargement of right ventricle 54. Pathophysiology and pathogenesis6

5、 A. pulmonary arterial hypertension1). 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 nerve73). remodeling of pulmonary vessels vasoconstrictio

6、n of vessels hypertrophy of smooth muscle cell 4). increased blood volume and increased blood viscosity hypoxia RBC blood viscosity resistance of blood flow 8Load of right ventricle and hypertrophy of right ventricle early stage: compensated acute exacerbation :incompetency cardiac output B. Changes

7、 of right heart function9 C. Impairment of the other important organsBrain, liver, kidney digestive canal, et al105.Clinic findings1).compensated stage(include remittent stage) signs: cough, sputum, wheeze, exertional dyspnea, edema of low limb, exercise intolerance physical examination decreased br

8、eath sounds, rhonchi or moist rales distance of the cardiac sound P2A2 the upper border of the liver 2).incompensated stage(include acute exacerbation) respiratory failure ( induced by infection) heart failure116. Complications1). pulmonary encephalopathy: main cause of death2). imbalance of acid an

9、d alkaline, disturbance of electrolytes3). arrhythmia4). shock: infection, blood loss, cardiac5). digestive bleeding6). DIC127. Laboratory findings and other examinationsa. Chest X-ray the sign of pulmonary arterial hypertension the width of right-inferior pulmonary artery15mm extruding of pulmonary

10、 artery segment enlargement of right ventricle 13b.EKG hypertrophy of right ventriclePulmonary P waveRv1+Sv51.05mVV1,2,3 lead: Qs, V5 R/S30mmInner diameter of right ventricle 20mmInner diameter of pulmonary artery :increased14e.blood gas analysisPaCO2 , PaO2 , HCO3 , AB ,PH normal or , f. blood test

11、 RBC, Hb , blood viscosity WBC , P K+, Na+, Cl-, Ca+,Mg+158.Diagnosis1. chronic bronchitis, emphysema, disorders of chest and lung, disorders of pulmonary vessels, et alpulmonary arterial hypertension , right heart failure2. corresponding symptoms and signs, X-ray, EKG, lung function test 169.Differ

12、ential diagnosis1).coronary heart diseases angina pectoris, myocardial infarction, hypertension, hyperlipidemia, diabetes, EKG: hypertrophy of left ventricle2).rheumatic valvular heart diseases Rheumatic arthritis, mitral and aortic valvular disorders3).primary cardiomyopathies enlargement of the wh

13、ole heart without chronic respiratory history and pulmonary arterial hypertension 1710.TreatmentA. control infection select effective antibioticsB. free the airway: treat hypoxia and hypercapnia C. control heart failure18control heart failure1) Diuretics: mild diuretics, avoid low K+ and low Cl-2) Digitalis: small dosage(1/2-2/3dose), fast excretion and onset3)vasodilators:decrease pulmonary artery pressur