肺心病-英文版課件

ChronicPulmonaryheartdisease

1.Definition

Itisdirectlycausedbychronicalterationsinpulmonarycirculationorchronicchestdiseasesthatleadtopulmonaryarterialhypertension,rightventricularenlargement,evenrightheartfailure.

ChronicPulmonaryheartdise12.EtiologyA.

Bronchialandpulmonarydisorders：chronicbronchitiscomplicatedwith

COPD:

80－90%

asthma,bronchiectasis,tuberculosis,silicosis,chronicinterstitiallungdiseaseB.

Disordersofchestmovement:（rare）abnormality,adhesion,vertebraltuberculosis、rhumatoidspondylitis。2.EtiologyA.Bronchialandpu2

2.EtiologyC.DisordersofnerveandmusclePoliomyelitisdisordersofmotor-nervecenterD.

DisordersofpulmonaryvesselsHypersensitvegranuloma

embolismofpulmonaryarteryE.

pulmonaryarterialhypertensionofunknowncause2.EtiologyC.Disordersofn33.Pathology1).

mainprimarydisordersoflungchronicbronchitisandemphysema2).changesofpulmonaryvessels

A.thewallofpulmonaryvesselsthickening,narrowing,orobliterativeB.capillarybedofalveolarwalldamaged,decreased

C.vascularbedoflungcompressedtobeirregular3.Pathology1).mainprimarydi4

3.Pathology3).changesoftheheartincreasedheartweighthypertrophyofrightventricleenlargementofrightventricle

3.Pathology3).changesof54.Pathophysiology

andpathogenesis4.Pathophysiology

6

A.pulmonaryarterialhypertension1).organicchangesofpulmonaryvesselsa.thickeningofthevesselsb.deteriorationofemphysemac.Decreasedcapillarybed:>70%2).functionalchangesofpulmonaryvesselsfactorsofbodyfluid,tissueandnerveA.pulmonaryarterialhypert73).remodelingofpulmonaryvesselsvasoconstrictionofvesselshypertrophyofsmoothmusclecell4).increasedbloodvolumeandincreasedbloodviscosity

hypoxiaRBCbloodviscosityresistanceofbloodflow3).remodelingofpulmonaryve8Loadofrightventricleandhypertrophyofrightventricle

earlystage:compensated

acuteexacerbation:incompetencycardiacoutput

B.ChangesofrightheartfunctionLoadofrightventricleand9

C.Impairmentoftheother

importantorgansBrain,liver,kidneydigestivecanal,etalC.Impairmentoftheother105.Clinicfindings1).compensatedstage(includeremittentstage)

signs:cough,sputum,wheeze,exertionaldyspnea,edemaoflowlimb,exerciseintolerance

physicalexaminationdecreasedbreathsounds,rhonchiormoistralesdistanceofthecardiacsoundP2>A2theupperborderoftheliver2).incompensatedstage(includeacuteexacerbation)respiratoryfailure(inducedbyinfection)heartfailure5.Clinicfindings1).compensate116.Complications1).pulmonaryencephalopathy:maincauseofdeath2).imbalanceofacidandalkaline,disturbanceofelectrolytes3).arrhythmia4).shock:infection,bloodloss,cardiac5).digestivebleeding6).DIC6.Complications1).pulmonary127.Laboratoryfindingsandother

examinationsa.ChestX-raythesignofpulmonaryarterialhypertensionthewidthofright-inferiorpulmonaryartery>15mmextrudingofpulmonaryarterysegmentenlargementofrightventricle7.Laboratoryfindingsandoth13b.EKG

hypertrophyofrightventriclePulmonaryPwaveRv1+Sv5>1.05mVV1,2,3lead:Qs,V5R/S<1c.VectorcardiogramEnlargementofrightatriumandrightventricle

d.EchocardiogramInnerdiameterofoutflowductofrightventricle>30mmInnerdiameterofrightventricle>20mmInnerdiameterofpulmonaryartery:increasedb.EKG14e.bloodgasanalysisPaCO2

,PaO2

,HCO3

,AB

,PHnormalor,f.bloodtest

RBC,Hb,bloodviscosityWBC,PK+,Na+,Cl-,Ca++,Mg++e.bloodgasanalysis158.Diagnosis1.chronicbronchitis,emphysema,disordersofchestandlung,disordersofpulmonaryvessels,etalpulmonaryarterialhypertension,rightheartfailure2.correspondingsymptomsandsigns,X-ray,EKG,lungfunctiontest8.Diagnosis1.chronicbronchit169.Differentialdiagnosis1).coronaryheartdiseasesanginapectoris,myocardialinfarction,hypertension,hyperlipidemia,diabetes,

EKG:hypertrophyofleftventricle2).rheumaticvalvularheartdiseasesRheumaticarthritis,mitralandaorticvalvulardisorders3).primarycardiomyopathiesenlargementofthewholeheartwithoutchronicrespiratoryhistoryandpulmonaryarterialhypertension

9.Differentialdiagnosis1).cor1710.TreatmentA.controlinfectionselecteffectiveantibioticsB.freetheairway:treathypoxiaandhypercapniaC.controlheartfailure10.TreatmentA.controlinfecti18controlheartfailure1)Diuretics:milddiuretics,avoidlow

K+

andlowCl-2)Digitalis:smalldosage(1/2-2/3dose),fastexcretionandonset3)vasodilators:decreasepulmonaryarterypressure,Ca++blocker4)controlarrhythmia5)strengthennursing6)remittentstagerelievetheinducedfactors,exercise,Chinesemedicine,etal.controlheartfailure1)Diuret1911.Prognosislungfunctionworseningprognosismortalityrate:10-15%.11.Prognosislungfunction20

ChronicPulmonaryheartdisease

1.Definition

Itisdirectlycausedbychronicalterationsinpulmonarycirculationorchronicchestdiseasesthatleadtopulmonaryarterialhypertension,rightventricularenlargement,evenrightheartfailure.

ChronicPulmonaryheartdise212.EtiologyA.

Bronchialandpulmonarydisorders：chronicbronchitiscomplicatedwith

COPD:

80－90%

asthma,bronchiectasis,tuberculosis,silicosis,chronicinterstitiallungdiseaseB.

Disordersofchestmovement:（rare）abnormality,adhesion,vertebraltuberculosis、rhumatoidspondylitis。2.EtiologyA.Bronchialandpu22

2.EtiologyC.DisordersofnerveandmusclePoliomyelitisdisordersofmotor-nervecenterD.

DisordersofpulmonaryvesselsHypersensitvegranuloma

embolismofpulmonaryarteryE.

pulmonaryarterialhypertensionofunknowncause2.EtiologyC.Disordersofn233.Pathology1).

mainprimarydisordersoflungchronicbronchitisandemphysema2).changesofpulmonaryvessels

A.thewallofpulmonaryvesselsthickening,narrowing,orobliterativeB.capillarybedofalveolarwalldamaged,decreased

C.vascularbedoflungcompressedtobeirregular3.Pathology1).mainprimarydi24

3.Pathology3).changesoftheheartincreasedheartweighthypertrophyofrightventricleenlargementofrightventricle

3.Pathology3).changesof254.Pathophysiology

andpathogenesis4.Pathophysiology

26

A.pulmonaryarterialhypertension1).organicchangesofpulmonaryvesselsa.thickeningofthevesselsb.deteriorationofemphysemac.Decreasedcapillarybed:>70%2).functionalchangesofpulmonaryvesselsfactorsofbodyfluid,tissueandnerveA.pulmonaryarterialhypert273).remodelingofpulmonaryvesselsvasoconstrictionofvesselshypertrophyofsmoothmusclecell4).increasedbloodvolumeandincreasedbloodviscosity

hypoxiaRBCbloodviscosityresistanceofbloodflow3).remodelingofpulmonaryve28Loadofrightventricleandhypertrophyofrightventricle

earlystage:compensated

acuteexacerbation:incompetencycardiacoutput

B.ChangesofrightheartfunctionLoadofrightventricleand29

C.Impairmentoftheother

importantorgansBrain,liver,kidneydigestivecanal,etalC.Impairmentoftheother305.Clinicfindings1).compensatedstage(includeremittentstage)

signs:cough,sputum,wheeze,exertionaldyspnea,edemaoflowlimb,exerciseintolerance

physicalexaminationdecreasedbreathsounds,rhonchiormoistralesdistanceofthecardiacsoundP2>A2theupperborderoftheliver2).incompensatedstage(includeacuteexacerbation)respiratoryfailure(inducedbyinfection)heartfailure5.Clinicfindings1).compensate316.Complications1).pulmonaryencephalopathy:maincauseofdeath2).imbalanceofacidandalkaline,disturbanceofelectrolytes3).arrhythmia4).shock:infection,bloodloss,cardiac5).digestivebleeding6).DIC6.Complications1).pulmonary327.Laboratoryfindingsandother

examinationsa.ChestX-raythesignofpulmonaryarterialhypertensionthewidthofright-inferiorpulmonaryartery>15mmextrudingofpulmonaryarterysegmentenlargementofrightventricle7.Laboratoryfindingsandoth33b.EKG

hypertrophyofrightventriclePulmonaryPwaveRv1+Sv5>1.05mVV1,2,3lead:Qs,V5R/S<1c.VectorcardiogramEnlargementofrightatriumandrightventricle

d.EchocardiogramInnerdiameterofoutflowductofrightventricle>30mmInnerdiameterofrightventricle>20mmInnerdiameterofpulmonaryartery:increasedb.EKG34e.bloodgasanalysisPaCO2

,PaO2

,HCO3

,AB

,PHnormalor,f.bloodtest

RBC,Hb,bloodviscosityWBC,PK+,Na+,Cl-,Ca++,Mg++e.bloodgasanalysis358.Diagnosis1.chronicbronchitis,emphysema,disordersofchestandlung,disordersofpulmonaryvessels,etalpulmonaryarterialhypertension,rightheartfailure2.correspondingsymptomsandsigns,X-ray,EKG,lungfunctiontest8.Diagnosis1.chronicbronchit369.Differentialdiagn