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.2.EtiologywA.Bronchial and pulmonary disorders：chronic bronc
2、hitis complicated with COPD:8090%asthma,bronchiectasis,tuberculosis,silicosis,chronic interstitial lung diseasewB.Disorders of chest movement:（rare）abnormality,adhesion,vertebral tuberculosis、rhumatoid spondylitis。2.EtiologywC.Disorders of nerve and musclePoliomyelitisdisorders of motor-nerve center
3、wD.Disorders of pulmonary vessels Hypersensitve granuloma embolism of pulmonary arteryE.pulmonary arterial hypertension of unknown cause3.Pathologyw1).main primary disorders of lung chronic bronchitis and emphysemaw2).changes of pulmonary vessels A.the wall of pulmonary vessels thickening,narrowing,
4、or obliterative B.capillary bed of alveolar wall damaged,decreased C.vascular bed of lung compressed to be irregular 3.Pathologyw3).changes of the heart increased heart weight hypertrophy of right ventricle enlargement of right ventricle 4.Pathophysiology and pathogenesis A.pulmonary arterial hypert
5、ensionw1).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 nervew3).remodeling of pulmonary vessels vasoconstriction of vessels hypertrophy of smooth
6、 muscle cell w4).increased blood volume and increased blood viscosity hypoxia RBC blood viscosity resistance of blood flow wLoad of right ventricle and hypertrophy of right ventricle early stage:compensated acute exacerbation:incompetency cardiac output B.Changes of right heart function C.Impairment
7、 of the other important organswBrain,liver,kidney wdigestive canal,et al5.Clinic findingsw1).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 t
8、he cardiac sound P2A2 the upper border of the liver w2).incompensated stage(include acute exacerbation)respiratory failure(induced by infection)heart failure6.Complicationsw1).pulmonary encephalopathy:main cause of deathw2).imbalance of acid and alkaline,disturbance of electrolytesw3).arrhythmiaw4).
9、shock:infection,blood loss,cardiacw5).digestive bleedingw6).DIC7.Laboratory findings and other examinationswa.Chest X-ray the sign of pulmonary arterial hypertension the width of right-inferior pulmonary artery15mm extruding of pulmonary artery segment enlargement of right ventricle wb.EKG hypertrop
10、hy of right ventriclePulmonary P waveRv1+Sv51.05mVV1,2,3 lead:Qs,V5 R/S30mmInner diameter of right ventricle 20mmInner diameter of pulmonary artery:increasedwe.blood gas analysisPaCO2 ,PaO2 ,HCO3 ,AB ,PH normal or ,wf.blood test RBC,Hb ,blood viscosity WBC ,P K+,Na+,Cl-,Ca+,Mg+8.Diagnosis1.chronic b
11、ronchitis,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 9.Differential diagnosis1).coronary heart diseases angina pectoris,myocardial infarction,hypertension
12、,hyperlipidemia,diabetes,EKG:hypertrophy of left ventricle2).rheumatic valvular heart diseases Rheumatic arthritis,mitral and aortic valvular disorders3).primary cardiomyopathies enlargement of the whole heart without chronic respiratory history and pulmonary arterial hypertension 10.TreatmentA.cont
13、rol infection select effective antibioticsB.free the airway:treat hypoxia and hypercapnia C.control heart failurecontrol heart failurew1)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.11.Prognosis lung function worsening prognosis mortality rate:10-15%.
