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8肺心病英文中山大学内科学8肺心病英文中山大学内科学1肺心病英文-内科学课件2肺心病英文-内科学课件3MechanismandPathology(一)Pulmonaryhypertension:Definition:meanpulmonaryarterypressure(mPAP)≥25mmHgatrestor≥30mmHgduringexercise.FunctionalchangesinpulmonaryvascularHypoxia,Hypercapnia,Respiratoryacidosis,vasoconstrictionsubstances→Pulmonaryvasoconstriction→PulmonaryhypertensionHypoxiaisthemostimportantfactorleadstopulmonaryhypertensionAnatomicchangesinpulmonaryvascularRemodelingofpulmonaryvesselsIncreasedbloodviscosityandbloodvolumeMechanismandPathology(一)Pulm4MechanismandPathology(二)Dysfunctionofrightheart
Pulmonaryhypertension→Afterloadofrightventricular
↑,Oxygensupplyofmyocardium↓→Hypertrophyanddilatationoftherightventricle→Rightheartfailure
(三)Damagestoothervitalorgans:
MultipleorgandysfunctionMechanismandPathology(二)Dysf5ClinicalManifestationsCompensationstageofcardiacandlungfunctionSymptoms:cough,sputum,shortofbreath;dyspneaandpalpitationonexertion;fatigueanddecreaseofexercisetolerance;exacerbatedbyacuteinfection.Signs:cyanosis,signsofemphysema,moistralesand/orrhonchi;P2>A2,systolicmurmuroftricuspidarea,subxiphoidvisible/palpablecardiacimpulse,distendedjugularvenous.ClinicalManifestationsCompens6ClinicalManifestationsDecompensationstageofcardiacandlungfunction
Respiratoryfailure
Symtoms:severedyspnea,especiallyatnight,headache,insomnia,inappetence,somnolence,dizziness,confusion,evendelirium.Signs:conjunctivacongestionandedema,retinalvasodilatation,opticpapillaryedema;weaknessordisappearofdeepreflexes,pathologicalreflexes.
ClinicalManifestationsDecompe7ClinicalManifestationsDecompensationstageofcardiacandlungfunction
RightheartfailureSymtoms:dyspneaaggravated,palpitation,inappetence,abdominaldistention,nausea.Signs:cyanosis,arrhythmia,tachycardia,subxiphoidsystolicmurmurorevendiastolicmurmur.Tenderhepatomegaly,Hepatojugularreflux,lowerextremityedema,ascites.
ClinicalManifestationsDecompe8
Chestradiography:Enlargedrightdescendingpulmonaryarterydiameter
≥15mm;Theratioofdiameterofrightdescendingpulmonaryarterytotrachea≥1.07;Rightdescendingpulmonaryarterybroadens>2mmduringdynamicobservationBulgeof
themiddlesegmentofpulmonaryarteryorwiththeheight≥3mmEnlargementofthepulmonaryarteriesandthemajorbranches,withmarkedtaperingofperipheralarteriesPulmonarycone
protrudesorwiththeheight≥7mmRightventricularhypertrophyLaboratoryassessmentChestradiography:Laborator9肺心病英文-内科学课件10Electrocardiography:
Maincriteria:Meanfrontalplaneelectricalaxis≥90°V1R/S≥1Markedclockwiserotationoftheelectricalaxis:V5R/S≤1Rv1+Sv5>1.05mVaVRR/SorR/Q≥1V1~V3:QS,Qr,qr(excludingmyocardialinfarction)P-pulmonale(tallpeakedPwavesinleadII)Secondarycriteria:LowvoltageQRSwaveformsinlimbleadsRightbundlebranchblockLaboratoryassessmentElectrocardiography:Laboratory11肺心病英文-内科学课件12
EchocardiographyTheinnerdiameterofrightventricularoutflow≥30mmTherightventricularinternaldimension≥20mmAnteriorrightventricularwallthickened,orwiththepulsationamplitudeincreaseRatiooflefttorightventricularinternaldimension<2Increasedinnerdiameterofrightpulmonaryartery≥18mmorpulmonaryarterytrunk≥20mmRatioofrightventricularoutflowinnerdiametertoleftatriuminternaldimension>1.4PulmonaryvalvecurveshowsthehypertentionofpulmonarycirculationLaboratoryassessmentEchocardiographyLaboratoryas13VectorcardiogramMoresensitivethanECG:positiverate80-95%Graphicshowthehypertrophyofrightheart
Arterialbloodgasanalysis:
Hypoxemiaand/orhypercapniaRespiratoryfailure:PaO2<60mmHg
PaCO2>50mmHg
Bloodtest:
Acid-baseandelectrolyteimbalanceBloodviscosity
↑RBCcountandhemoglobin↑WBCcountandneutrophilicratio↑wheninfectionoccursLaboratoryassessmentVectorcardiogramLaboratorya14MedicalhistoryofCOPDandotherlungorpulmonaryvasculardiseases.Symptomsandsignsofprimarydisease,pulmonaryhypertension,rightventricularhypertrophyordysfunctionofrightheartLabfindings:EKG;X-ray;UCG,etal.Diagnosis
MedicalhistoryofCOPDandot15DifferentialdiagnosisCoronaryheartdiseasePrimarycardiomyopathyRheumaticheartdiseaseCyanoticcongenitalheartdiseaseDifferentialdiagnosisCoronary16CompensationstageTreatmentofprimarydiseaseEliminatethepredisposingfactors,avoidtheacuteexacerbationtorestoretheheartandlungfunction
TreatmentCompensationstageTreatment17DecompensationstageTreatmentofrespiratoryfailureTreatmentofrightheartfailureTreatmentDecompensationstageTreatment18Treatmentofrespiratoryfailure
AntimicrobialtreatmentBronchodilators,expectorantsSputumaspiration,airwaymaintenanceOxygentherapyCorrecttheacid-baseandelectrolyteimbalanceTreatmentTreatmentofrespiratoryfailu19TreatmentofrightheartfailureOxygentherapy,infectioncontrolandthemeasurestoimproverespiratoryfunctioncanamelioratethethesymptomsofheartfailureinmostcasesAppropriatediuretics,cardiotonicsandvasodilatorscanbechosenwhenthetreatmentsmentionedabovefailsTreatmentTreatment20TreatmentofrightheartfailureDiuretics:Principle:Combinepotassium-sparingdiureticsandthediureticsthatdischargespotassium;Lowdosage,shortperiodandintermittentuse.Treatmentofrightheartfailu21TreatmentofrightheartfailureCardiotonics:
Principle:Lowdosage,rapideffectandexcreted(cedilanid,strophanthinK),correctionofhypoxiaandhypokalemiabeforeuse.Indications:①Heartfailurecan’tbeimprovedafterinfectioncontroled,respiratoryfunctionimprovedanddiureticsused②supraventriculartachyarrhythmia③Rightheartfailurewithoutacuteinfection④AcuteleftheartfailureTreatmentofrightheartfailu22TreatmentofrightheartfailureVasodilatorsDilatesthepulmonaryatery→pressureofpulmonaryatery↓
→
loadoftherightheart↓→improvethe
rightheartfunctionAdverseeffect:bloodpressure↓,bloodflowofcoronaryatery
↓,
ventilation/perfusionratio↓
→
hypoxemiaTreatmentofrightheartfailu23
TreatmentofComplicationsPulmonaryencephalopathyAcid-baseandelectrolytedisturbanceArrhythmia:atrialprematurecontractions,paroxysmalsupraventriculartachycardia,chaoticatrialtachycardiaisthemostspecificShockGastrointestinalhemorrhageDICTreatmentofComplicationsPul24谢谢!谢谢!258肺心病英文中山大学内科学8肺心病英文中山大学内科学26肺心病英文-内科学课件27肺心病英文-内科学课件28MechanismandPathology(一)Pulmonaryhypertension:Definition:meanpulmonaryarterypressure(mPAP)≥25mmHgatrestor≥30mmHgduringexercise.FunctionalchangesinpulmonaryvascularHypoxia,Hypercapnia,Respiratoryacidosis,vasoconstrictionsubstances→Pulmonaryvasoconstriction→PulmonaryhypertensionHypoxiaisthemostimportantfactorleadstopulmonaryhypertensionAnatomicchangesinpulmonaryvascularRemodelingofpulmonaryvesselsIncreasedbloodviscosityandbloodvolumeMechanismandPathology(一)Pulm29MechanismandPathology(二)Dysfunctionofrightheart
Pulmonaryhypertension→Afterloadofrightventricular
↑,Oxygensupplyofmyocardium↓→Hypertrophyanddilatationoftherightventricle→Rightheartfailure
(三)Damagestoothervitalorgans:
MultipleorgandysfunctionMechanismandPathology(二)Dysf30ClinicalManifestationsCompensationstageofcardiacandlungfunctionSymptoms:cough,sputum,shortofbreath;dyspneaandpalpitationonexertion;fatigueanddecreaseofexercisetolerance;exacerbatedbyacuteinfection.Signs:cyanosis,signsofemphysema,moistralesand/orrhonchi;P2>A2,systolicmurmuroftricuspidarea,subxiphoidvisible/palpablecardiacimpulse,distendedjugularvenous.ClinicalManifestationsCompens31ClinicalManifestationsDecompensationstageofcardiacandlungfunction
Respiratoryfailure
Symtoms:severedyspnea,especiallyatnight,headache,insomnia,inappetence,somnolence,dizziness,confusion,evendelirium.Signs:conjunctivacongestionandedema,retinalvasodilatation,opticpapillaryedema;weaknessordisappearofdeepreflexes,pathologicalreflexes.
ClinicalManifestationsDecompe32ClinicalManifestationsDecompensationstageofcardiacandlungfunction
RightheartfailureSymtoms:dyspneaaggravated,palpitation,inappetence,abdominaldistention,nausea.Signs:cyanosis,arrhythmia,tachycardia,subxiphoidsystolicmurmurorevendiastolicmurmur.Tenderhepatomegaly,Hepatojugularreflux,lowerextremityedema,ascites.
ClinicalManifestationsDecompe33
Chestradiography:Enlargedrightdescendingpulmonaryarterydiameter
≥15mm;Theratioofdiameterofrightdescendingpulmonaryarterytotrachea≥1.07;Rightdescendingpulmonaryarterybroadens>2mmduringdynamicobservationBulgeof
themiddlesegmentofpulmonaryarteryorwiththeheight≥3mmEnlargementofthepulmonaryarteriesandthemajorbranches,withmarkedtaperingofperipheralarteriesPulmonarycone
protrudesorwiththeheight≥7mmRightventricularhypertrophyLaboratoryassessmentChestradiography:Laborator34肺心病英文-内科学课件35Electrocardiography:
Maincriteria:Meanfrontalplaneelectricalaxis≥90°V1R/S≥1Markedclockwiserotationoftheelectricalaxis:V5R/S≤1Rv1+Sv5>1.05mVaVRR/SorR/Q≥1V1~V3:QS,Qr,qr(excludingmyocardialinfarction)P-pulmonale(tallpeakedPwavesinleadII)Secondarycriteria:LowvoltageQRSwaveformsinlimbleadsRightbundlebranchblockLaboratoryassessmentElectrocardiography:Laboratory36肺心病英文-内科学课件37
EchocardiographyTheinnerdiameterofrightventricularoutflow≥30mmTherightventricularinternaldimension≥20mmAnteriorrightventricularwallthickened,orwiththepulsationamplitudeincreaseRatiooflefttorightventricularinternaldimension<2Increasedinnerdiameterofrightpulmonaryartery≥18mmorpulmonaryarterytrunk≥20mmRatioofrightventricularoutflowinnerdiametertoleftatriuminternaldimension>1.4PulmonaryvalvecurveshowsthehypertentionofpulmonarycirculationLaboratoryassessmentEchocardiographyLaboratoryas38VectorcardiogramMoresensitivethanECG:positiverate80-95%Graphicshowthehypertrophyofrightheart
Arterialbloodgasanalysis:
Hypoxemiaand/orhypercapniaRespiratoryfailure:PaO2<60mmHg
PaCO2>50mmHg
Bloodtest:
Acid-baseandelectrolyteimbalanceBloodviscosity
↑RBCcountandhemoglobin↑WBCcountandneutrophilicratio↑wheninfectionoccursLaboratoryassessmentVectorcardiogramLaboratorya39MedicalhistoryofCOPDandotherlungorpulmonaryvasculardiseases.Symptomsandsignsofprimarydisease,pulmonaryhypertension,rightventricularhypertrophyordysfunctionofrightheartLabfindings:EKG;X-ray;UCG,etal.Diagnosis
MedicalhistoryofCOPDandot40DifferentialdiagnosisCoronaryheartdiseasePrimarycardiomyopathyRheumaticheartdiseaseCyanoticcongenitalheartdiseaseDifferentialdiagnosisCoronary41CompensationstageTreatmentofprimarydiseaseEliminatethepredisposingfactors,avoidtheacuteexacerbationtorestoretheheartandlungfunction
TreatmentCompensationstageTreatment42DecompensationstageTreatmentofrespiratoryfailureTreatmentofrightheartfailureTreatmentDecompensationstageTreatment43Treatmentofrespiratoryfailure
AntimicrobialtreatmentBronchodilators,expectorantsSputumaspiration,airwaymaintenanceOxygentherapyCorrecttheacid-baseandelectrolyteimbalanceTreatmentTreatmentofrespiratoryfailu44TreatmentofrightheartfailureOxygentherapy,infectioncontrolandthemeasurestoimproverespiratoryfunctioncanamelioratethethesymptomsofheartfailureinmostcasesAppropriatediuretics,cardiotonicsandvasodilatorscanbec
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