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.第1页，共20页。2.EtiologywA.Bronchial and pulmonary disorders：chro
2、nic bronchitis complicated with COPD:8090%asthma,bronchiectasis,tuberculosis,silicosis,chronic interstitial lung diseasewB.Disorders of chest movement:（rare）abnormality,adhesion,vertebral tuberculosis、rhumatoid spondylitis。第2页，共20页。2.EtiologywC.Disorders of nerve and musclePoliomyelitisdisorders of
3、motor-nerve centerwD.Disorders of pulmonary vessels Hypersensitve granuloma embolism of pulmonary arteryE.pulmonary arterial hypertension of unknown cause第3页，共20页。3.Pathologyw1).main primary disorders of lung chronic bronchitis and emphysemaw2).changes of pulmonary vessels A.the wall of pulmonary ve
4、ssels thickening,narrowing,or obliterative B.capillary bed of alveolar wall damaged,decreased C.vascular bed of lung compressed to be irregular第4页，共20页。3.Pathologyw3).changes of the heart increased heart weight hypertrophy of right ventricle enlargement of right ventricle 第5页，共20页。4.Pathophysiology
5、and pathogenesis第6页，共20页。A.pulmonary arterial hypertensionw1).organic changes of pulmonary vessels a.thickening of the vessels b.deterioration of emphysema c.Decreased capillary bed:70%w2).functional changes of pulmonary vessels factors of body fluid,tissue and nerve第7页，共20页。w3).remodeling of pulmon
6、ary vessels vasoconstriction of vessels hypertrophy of smooth muscle cell w4).increased blood volume and increased blood viscosity hypoxia RBC blood viscosity resistance of blood flow 第8页，共20页。wLoad of right ventricle and hypertrophy of right ventricle early stage:compensated acute exacerbation:inco
7、mpetency cardiac output B.Changes of right heart function第9页，共20页。C.Impairment of the other important organswBrain,liver,kidney wdigestive canal,et al第10页，共20页。5.Clinic findingsw1).compensated stage(include remittent stage)signs:cough,sputum,wheeze,exertional dyspnea,edema of low limb,exercise intol
8、erance physical examination decreased breath sounds,rhonchi or moist rales distance of the cardiac sound P2A2 the upper border of the liver w2).incompensated stage(include acute exacerbation)respiratory failure(induced by infection)heart failure第11页，共20页。6.Complicationsw1).pulmonary encephalopathy:m
9、ain cause of deathw2).imbalance of acid and alkaline,disturbance of electrolytesw3).arrhythmiaw4).shock:infection,blood loss,cardiacw5).digestive bleedingw6).DIC第12页，共20页。7.Laboratory findings and other examinationswa.Chest X-ray the sign of pulmonary arterial hypertension the width of right-inferio
10、r pulmonary artery15mm extruding of pulmonary artery segment enlargement of right ventricle 第13页，共20页。wb.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:increased第14页，共20页。we.blood gas an
11、alysisPaCO2 ,PaO2 ,HCO3 ,AB ,PH normal or ,wf.blood test RBC,Hb ,blood viscosity WBC ,P K+,Na+,Cl-,Ca+,Mg+第15页，共20页。8.Diagnosis1.chronic bronchitis,emphysema,disorders of chest and lung,disorders of pulmonary vessels,et alpulmonary arterial hypertension,right heart failure2.corresponding symptoms an
12、d signs,X-ray,EKG,lung function test 第16页，共20页。9.Differential 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
13、).primary cardiomyopathies enlargement of the whole heart without chronic respiratory history and pulmonary arterial hypertension 第17页，共20页。10.TreatmentA.control infection select effective antibioticsB.free the airway:treat hypoxia and hypercapnia C.control heart failure第18页，共20页。control heart failu
14、rew1)Diuretics:mild diuretics,avoid low K+and low Cl-w2)Digitalis:small dosage(1/2-2/3dose),fast excretion and onsetw3)vasodilators:decrease pulmonary artery pressure,Ca+blockerw4)control arrhythmiaw5)strengthen nursingw6)remittent stage relieve the induced factors,exercise,Chinese medicine,et al.第19页，共20页。11.Prognosis lung function worsening prognosis mortality rate:10-15%.第20页，共20页。
