1、Chronic Pulmonary heart disease,复旦大学上海医科大学附属华山医院呼吸科 张斯为,Chronic Pulmonary heart disease 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.,Ep
2、idemiology,70 years morbidity 40y 0.46% 90 years morbidity 15y 0.70， countycity north south malefemale smokeno smoke agednessyoung 51604150 high 23倍 Different cardiopathy in hospital 535,Etiology,1. Bronchial and pulmonary disorders：chronic bronchitis complicated with COPD: 8090%asthma, bronchiectas
3、is, tuberculosis, silicosis, chronic interstitial lung disease 2. Disorders of chest movement:（rare）abnormality,adhesion, vertebral tuberculosis、rheumatoid spondylitis 。,Etiology,3. Disorders of pulmonary vessel: pulmonary arterial hypertension of unknown causeHypersensitive granuloma embolism of pu
4、lmonary artery 4. other: Disorders of nerve and muscle Poliomyelitis disorders of motor-nerve center,Pathology,1). main primary disorders of lungchronic bronchitis and emphysema 2). changes of pulmonary vesselsA. the wall of pulmonary vesselsthickening, narrowing, or obliterativeB. capillary bed of
5、alveolar walldamaged , decreasedC. vascular bed of lung compressed to be irregular,Pathology,3). changes of the heartincreased heart weighthypertrophy of right ventricleenlargement of right ventricle,pathogenesis,A. pulmonary arterial hypertension,1). organic changes of pulmonary vesselsa. thickenin
6、g of the vesselsb. deterioration of emphysema2). functional changes of pulmonary vesselsa.factors of body fluid:5-HT、At-II、LTs、TXA2 、PGF2 、PGE1、PGI2。b. factors of tissue c. factors of d nerve。,3). remodeling of pulmonary vesselsvasoconstriction of vesselshypertrophy of smooth muscle cell 4). increas
7、ed blood volume and increased blood viscosityhypoxia RBC blood viscosity resistance of blood flow ,Load of right ventricle and hypertrophy of right ventricleearly stage: compensatedacute exacerbation :incompetencycardiac output ,B. Changes of right heart function,C. Impairment of the other important
8、 organs,Brain, liver, kidney digestive canal, et al,Clinic findings,1).compensated stage(include remittent stage)signs: cough, sputum, wheeze, exertional dyspnea,edema of low limb, exercise intolerancephysical examinationdecreased breath sounds, rhonchi or moist ralesdistance of the cardiac soundP2A
9、2the upper border of the liver 2).incompensated stage(include acute exacerbation) respiratory failure ( induced by infection)heart failure,Complications,1). pulmonary encephalopathy: main cause of death 2). imbalance of acid and alkaline, disturbance of electrolytes 3). arrhythmia 4). shock: infecti
10、on, blood loss, cardiac 5). digestive bleeding 6). DIC,Laboratory findings and other examinations,a. Chest X-raythe sign of pulmonary arterial hypertensionthe width of right-inferior pulmonary artery15mmextruding of pulmonary artery segmentenlargement of right ventricle,b.EKGhypertrophy of right ven
11、tricle Pulmonary P wave Rv1+Sv51.05mV V1,2,3 lead: Qs, V5 R/S1 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 a
12、nalysis PaCO2 , PaO2 , HCO3 , AB , PH normal or , f. blood testRBC, Hb , blood viscosity WBC , P K+, Na+, Cl-, Ca+,Mg+,Diagnosis,1. chronic bronchitis, emphysema, disorders of chest and lung, disorders of pulmonary vessels, et al pulmonary arterial hypertension , right heart failure 2. corresponding
13、 symptoms and signs, X-ray, EKG, lung function test,Differential diagnosis,1).coronary heart diseasesangina pectoris, myocardial infarction,hypertension, hyperlipidemia, diabetes,EKG: hypertrophy of left ventricle 2).rheumatic valvular heart diseasesRheumatic arthritis, mitral and aortic valvular di
14、sorders 3).primary cardiomyopathiesenlargement of the whole heart without chronic respiratory history and pulmonary arterial hypertension,Treatment,A.compensated stage: B.incompensated stage:1.control infection2. select effective antibiotics3. free the airway: treat hypoxia and hypercapnia 4. contro
15、l 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 stagerelieve the induced factors , exercise ,Chinese medicine, et al.,Prognosis,lung function worsening prognosismortality rate: 10-15%.,Thank you,
