肺心病英文版课件

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.EtiologyA. Bronchial and pulmonary disorders： c

2、hronic bronchitis complicated with COPD: 8090% asthma, bronchiectasis, tuberculosis, silicosis, chronic interstitial lung diseaseB. Disorders of chest movement:（rare）abnormality, adhesion, vertebral tuberculosis、rhumatoid spondylitis 。第2页，共20页。 2.EtiologyC. Disorders of nerve and musclePoliomyelitis

3、disorders of motor-nerve centerD. Disorders of pulmonary vessels Hypersensitve granuloma embolism of pulmonary arteryE. pulmonary arterial hypertension of unknown cause第3页，共20页。3.Pathology1). main primary disorders of lung chronic bronchitis and emphysema2). changes of pulmonary vessels A. the wall

4、of pulmonary vessels 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.Pathology3). changes of the heart increased heart weight hypertrophy of right ventricle enlargement of right ventricle 第5页，共

5、20页。4. Pathophysiology and pathogenesis第6页，共20页。 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 nerve第7页，

6、共20页。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 第8页，共20页。Load of right ventricle and hypertrophy of right ventricle early stage: compen

7、sated acute exacerbation :incompetency cardiac output B. Changes of right heart function第9页，共20页。 C. Impairment of the other important organsBrain, liver, kidney digestive canal, et al第10页，共20页。5.Clinic findings1).compensated stage(include remittent stage) signs: cough, sputum, wheeze, exertional dy

8、spnea, edema of low limb, exercise intolerance physical examination decreased breath 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 failure第11页，共20页。6

9、. Complications1). pulmonary encephalopathy: main cause of death2). imbalance of acid and alkaline, disturbance of electrolytes3). arrhythmia4). shock: infection, blood loss, cardiac5). digestive bleeding6). DIC第12页，共20页。7. Laboratory findings and other examinationsa. Chest X-ray the sign of pulmona

10、ry arterial hypertension the width of right-inferior pulmonary artery15mm extruding of pulmonary artery segment enlargement of right ventricle 第13页，共20页。b.EKG hypertrophy of right ventriclePulmonary P waveRv1+Sv51.05mVV1,2,3 lead: Qs, V5 R/S30mmInner diameter of right ventricle 20mmInner diameter of

11、 pulmonary artery :increased第14页，共20页。e.blood gas analysisPaCO2 , PaO2 , HCO3 , AB ,PH normal or , f. 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 a

12、rterial hypertension , right heart failure2. corresponding symptoms and 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 va

13、lvular heart diseases Rheumatic arthritis, mitral and aortic valvular disorders3).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 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 pressure, Ca+bl