Pulmonary heart - a dilation or an increase in ventricular volumes, located on the right side of the heart, which have arisen as a consequence of pulmonary arterial hypertension.This is all due to the pathologies that affect the structure and operation of light not associated with abnormalities of the left side of the heart or congenital heart defects.
Pulmonary heart can be formed while having pathological changes in the lung, violations of the mechanisms of pulmonary respiration does not that provide the processes of lung ventilation, and various vascular lesions in the lung.
This disease, since 1964, is classified into acute heart, subacute and chronic.
For acute pulmonary heart disease characterized by
for subacute course of the disease characterized by recurrent thrombosis of small vessels of the pulmonary artery.
main feature of pulmonary heart is the emergence of increasing shortness of breath and lack of work of the right ventricle in the shortest possible time.In addition, there are several other reasons for the development of subacute, such as diseases of the neuromuscular etiology and miliary tuberculosis in the lung form to severe asthma.Very often, pulmonary heart develops as a result of cancer of the lungs, stomach, breast and squeezing spreading tumor vessels and the subsequent formation of thrombosis.
In 80% of chronic pulmonary heart form arises as a consequence of bronchopulmonary changes in general and is characterized by slowly rising in the pulmonary artery hypertension for prolonged period.
Pulmonary heart causes
in the development of this form of the disease bronchopulmonary paramount role played by various lesions of the respiratory system.Among them are a result of chronic obstructive bronchitis, bronchial asthma, tuberculosis, bronchiolitis, emphysema, diffuse pulmonary fibrosis, cystic disease, bronchiectasis, and others. About 80% of the diseases of the bronchi and lungs can trigger this form of heart disease.
torakodiafragmalnoy The causes of cardiac anomalies considered various lesions of the diaphragm and chest that disrupt the processes of hemodynamics and ventilation in the lungs.Among them are marked disease that expose the chest deformation (ankylosing spondylitis, kyphoscoliosis and many others), neuromuscular pathology of the disease, abnormalities of the pleura, and diaphragm (fibrosis, phrenic paresis, torakopastika syndrome Pikvicha on the background of obesity and others.).
Pulmonary heart vascular type is formed by vascular lesions in the lungs for the first time.Among them are the diseases such as pulmonary hypertension, vasculitis, pulmonary embolism, aortic aneurysm, atherosclerosis and tumors of the mediastinum.
Among the main reasons affecting the development of pulmonary heart in the acute form, emit massive pulmonary embolism, a heavy degree of occurrence of asthma, pneumothorax valves, acute pneumonia.The formation of pulmonary heart greatly affect repeated thromboembolism, pulmonary lymphangitis cancer, myasthenia gravis, botulism, and poliomyelitis.
In addition, pulmonary hypertension is paramount influence on the formation of pulmonary heart.At the beginning of the disease, she reflexively increases cardiac output, in response to increased respiration and tissue hypoxia, which develops due to poor function of the respiratory system.
Pulmonary heart symptoms
Clinical manifestations can grow at different rates, so the symptoms of pulmonary heart consists of an acute course of the disease, as well as subacute and chronic.
to pulmonary heart disease with an acute course characterized by a very rapid development.For subacute may require weeks or months, but chronic pulmonary heart is formed slowly, with having such diseases as respiratory failure.
in the formation of chronic pulmonary heart disease with its view over some of the stages.These include pre-clinical stage, which is characterized by transient hypertension and symptoms of stress right ventricular function;compensated stage, which manifests an increase in the ventricle on the right side of the heart and hypertension stable without signs of circulatory disorders;decompensated stage is characterized by symptoms of insufficient work of the right ventricle.
to chronic course characterized by signs of pulmonary heart compensation: compensated and decompensated heart.
All clinical symptoms such as pulmonary heart disease is based on the phenomenon of insufficient heart function in the presence of hypertension in the pulmonary artery.
Acute pulmonary heart formed with the appearance of spontaneous chest pain and sudden lack of air in the form of attacks of breathlessness.Then, greatly reduced blood pressure, which can cause collapse.Patients with marked cyanosis of the skin, swollen neck veins, and tachycardia increases.In addition, much progress in his enlarged liver with characteristic pain under the ribs on the right and growing agitation.Also marked epigastric and precordial pulsations, expands the heart to the right, with auscultation tapped gallop over the xiphoid process, the electrocardiogram is visible on the right atrial overload.
With very extensive pulmonary embolism within a short period of time of a few minutes may develop shock and pulmonary edema.Quite often it joins coronary insufficiency acute form, which is characterized by cardiac arrhythmias and occurrence of pain.In 35% of cases death.
Symptoms of subacute pulmonary heart disease can manifest itself in the form of suddenly appearing moderate pain, labored breathing, palpitations heartbeat, fainting, appearance of blood when coughing and signs of pleuropneumonia.
Compensation phase pulmonary heart observed with symptoms of underlying pathology, in which progressively manifested hyperactivity and further hypertrophy of the right heart.Sometimes, some patients determine the ripple in the upper abdomen, which is formed as a consequence of the increase of the right ventricle.
For dekompensatsionnoy stage is characterized by symptoms of right heart failure.In this case, there is difficulty breathing (dyspnea), after the load of a physical nature, breathing in the cold and in the supine position.Then there are pains in the heart, cyanosis, rapid heart rate, the veins in the neck begins to swell, but do not change during inhalation, hepatomegaly and edema peripheral nature, are resistant to treatments.
diagnostic evaluation of pulmonary heart notes voiceless tones the heart.Blood pressure may be normal or decreased.And also there is an increase of pressure in the form of lack of congestive heart function.
Signs of pulmonary heart become much severe, acute pneumonia when lungs.
In the later period of the disease is much worse edema, hepatomegaly progresses, neurological symptoms, such as drowsiness, lethargy, pain in the head and dizziness, as well as reduced daily urine.
Acute pulmonary heart
It is symptomatic complex occurring as a result of pulmonary embolism, and many diseases of the respiratory and cardiovascular systems.
Recent decades have seen a strong jump upwards to increase such diseases as acute pulmonary heart, which is associated with more frequent development of PE.A high percentage of embolism and thrombosis observed in patients suffering from coronary artery disease, hypertension, atherosclerosis, heart diseases and rheumatic etiology flebothrombosis.
For one of the underlying causes of the current acute pulmonary heart valve may include pneumothorax;massive pulmonary embolism (pulmonary embolism);protracted attack on the background of asthma and acute form of pneumonia.
When recurrent thromboembolism, lymphangitis cancer etiology, botulism, myasthenia can form an acute pulmonary heart, characterized by a subacute disease.There are many factors that contribute to the formation of pulmonary embolism.These include pulmonary hypertension, disorders of the microcirculation in the small circle, vasculitis and atherosclerosis, physical inactivity, surgery on the veins of the legs and pelvis.
pathogenesis of acute pulmonary heart education includes reflections, forming diffuse narrowing of the capillaries in the lungs and bronchopulmonary anastomoses develop bronchospasm, provoking reduction of pressure in a large circle.These pathophysiological mechanisms nature usually pressurized and increase pulmonary overvoltage right side of the heart.At the same time there is the permeability of the capillaries in the lungs, the output of fluid in the tissue with subsequent formation of pulmonary edema.
Symptoms of acute pulmonary heart develops rapidly, accompanied by phenomena of cardiac decompensation.Slightly slower growing disease with subacute syndrome.
Usually, a complex of acute symptomatic pulmonary heart flow there all of a sudden at the absolute well-being, and sometimes during exacerbation of chronic thrombophlebitis.This appears in the bluntly dyspnea, cyanosis then become skin, chest starts to hurt and sick at that point becomes highly agitated.But the main trunk of PE over a short period, about half an hour, can cause shock and death.
for subacute pulmonary heart disease is characterized by increasing dyspnea, followed by cyanosis, shock and lung edema.
While listening, you can find a lot of wheezing etiology wet and dry and scattered.Ripple is detected between the second or third rib on the left.In addition, swelling the veins on his neck, progressively increasing the liver, which is very painful on palpation.
Sometimes pulmonary heart develops coronary insufficiency in the acute form, which is characterized by pain, heart rhythm disturbance and electrocardiographic signs of myocardial ischemia are determined, as a rule, in patients with coronary artery disease.This raises the shock compressed tebezievye vein due to an increase in the right ventricle of the heart.
The effects of acute pulmonary heart during a heart attack due to the formation of lung and part of perifocal inflammation of the lung.Thus renewed or enhanced breast pain, usually during respiration continues present cyanosis and dyspnea, but to a lesser degree.Then develop a dry cough, sometimes with sputum.In addition, the majority of patients experiencing hemoptysis with increasing temperature, which is not treatable with antibiotics.
During the examination of patients with this form of the disease is marked persistent palpitations, very weak breathing with crackles of the affected part of the lung, as well as dry scattered wheezes.Very often it does not match the severity of the disease with minor physical lesions of the lungs.
Laboratory diagnosis reveals leukocytosis intermittent, very long ESR increased performance, change a number of biochemical tests (increased fibrinogen, globulins, CRP, sialic acid, and others.), Increases the activity of isoenzyme LDG3.By studying the blood coagulation system, there is hypercoagulation, fibrinolysis depression, and further develops hypocoagulation in connection with the activation process protivosvёrtyvaniya.
on X-ray revealed an increase in the shadow of the lung root on only one side, as well as increased transparency in the walls of the lung.Also, immediately determine the high position of the diaphragm from the affected lung, advanced venous vessels and increased the right side of the heart.
Acute pulmonary heart is diagnosed based on clinical symptoms, ECG data and X-ray examination.You also need to take into account the thrombosis in the lower extremities.Important diagnostic in determining PE takes pulmonary angiography, which allows you to determine the location of the affected area and the prevalence of disease.
At the time of development of shock and clinical death is carried out intubation, cardiac massage, apply mechanical ventilation.After the occurrence of the positive dynamics of the thrombus immediately removed from the pulmonary artery, or thrombolytic agents are administered in the artery with the probe.
In addition, pain relieved by analgesics neuroleptanalgesia drugs and narcotics;reduce pulmonary artery pressure eufillin, and in the absence of hypotension appoint ganglioplegic.Heart failure & shock treated with sympathomimetic, gluco-corticoids.
for the treatment of thromboembolism conducted early Antique agulyantnuyu therapy, starting with intravenous heparin 20,000 units, and in the future it is administered intramuscularly or subcutaneously, controlling blood clotting.At the same time appoint streptokinase, Fibrinolizin and others.
Chronic pulmonary heart
As a rule, this increase ventricle, located on the right side as a result of diseases that disrupt the functioning of the lungs and their structure.The exception in this case may be primary lung lesions, such as myocardial infarction, and heart defects.
For chronic course of the disease characterized by a gradual and slow the onset of pulmonary heart and hypertrophy of the prostate.This suggests compensated form of heart disease.At the time of formation of systole dysfunction of the right ventricle (RV) as a result of increased pressure in the lung artery is formed decompensated form of chronic disease course.
Risk factors for chronic pulmonary heart are those that will meet the basic pathology of the patient, but the stress and physical stress can cause severe deterioration.
the primary cause of chronic pulmonary heart flow can be attributed alveolar hypoxia, in which the predominant symptoms of respiratory failure.The increase in carbon dioxide in the blood or hypercapnia also provokes the formation of pulmonary heart.The delay of the gas in the body reduces lung ventilation works and causes pulmonary vasoconstriction.
Chronic pulmonary heart is classified into basic shapes such as torakodiafragmalnaya, bronchopulmonary and vascular.
Vascular chronic can be formed on the background of pulmonary vasculitis, primarily arising hypertension, thromboembolism, which has a relapse after surgery on the lung.Diffuse parenchymal lung and bronchus contribute to the emergence of forms of chronic bronchopulmonary flow pulmonary heart.First of all it can be chronic obstructive bronchitis and severe course of bronchial asthma, bronchiolitis, emphysema, pulmonary fibrosis, diffuse pulmonary fibrosis, granulomatosis, sarcoidosis, and pneumoconiosis.
torakodiafragmalnoy to form characteristic of its development against the backdrop of significant violations of ventilation in the lungs and blood in them after various deformities of the thoracic as kyphoscoliosis.In addition, if there is a pathology of the pleura and diaphragm manifested massive fibrothorax, ankylosing spondylitis, after thoracoplasty, as well as sleep apnea.
chronic pulmonary heart in its development is divided into three stages.First preclinical manifested as transient pulmonary hypertension, where the tense right ventricular function, which manages to identify only by instrumental examination.For the second stage is characterized by right ventricular hypertrophy and stable pulmonary hypertension without heart failure.