Pulmonary heart: causes, treatment and prognosis

Pulmonary heart pathology of the right heart divisions, characterized by the increase of the right ventricle and the Atria due to hypertension of the pulmonary circulation. Suffering as a result of the work of the heart and develop congestion in the systemic circulation. The development of the disease contribute to lung diseases, bronchopulmonary system and the pulmonary vessels. According to statistics, 3% of patients with diseases of the lungs confirmed the diagnosis. Pulmonary heart complicates the cardiomyopathy and takes the 4th place among causes of death in diseases of the blood vessels and heart.

 

As klassificeret disease?

As compensation chronic pulmonary heart is:

  • decompensated;
  • compensated.

Adrift distinguish three forms of the disease:

  • Sharp. This form develops very quickly, within several minutes to a few hours (days).
  • Subacute. The development of this form of the disease occurs within several days (weeks).
  • Chronic. Chronic pulmonary heart can be formed within a few years.
  • On the etiology of the disease can be:

  • Bronchopulmonary: this form of the disease cause pneumoconiosis, bronchial asthma, bronchitis.
  • Vascular: occurs when pathologies that affect the pulmonary vessels.
  • Thoracolumbalis: this form of the disease provoked, in violation of ventilation because of violations of the mobility of the thorax.
  • Symptoms and causes of acute form of the disease

    Acute pulmonary heart can develop due to:

  • Thromboembolism of the lung artery.
  • Fat embolism. This condition is a complication after fractures with fracture of long bones (e.g. the thigh bone).
  • A gas embolism. This is a disease in which the vessel is sealed with a gas bubble in some pathological conditions.
  • Cancer embolism. The artery is filled in metastatic cells.
  • Embolism amniotic fluid (the blood vessels are clogged drops of amniotic fluid).
  • Pneumothorax. It is a pathological process in which the cavity of the thorax enters the air.
  • Status asthmaticus, complicating the course of severe asthma.
  • Severe emphysema, which accumulates under the skin the air.
  • Inflammation of the lungs.
  • Acute pulmonary heart is manifested:

  • Intense shortness of breath.
  • Cyanosis of the skin.
  • Pain in the sternum.
  • Tachycardia.
  • The breath rate increases to 40 to 60 seconds.
  • Tension neck veins.
  • Faint.
  • Enlarged liver and pain in upper quadrant right.
  • Swelling of the legs.
  • In the subacute form of pulmonary heart disease develops over several days or even weeks. In this state there is heart failure, which can lead to death.

    Usually subacute form of the disease is characterized by sudden pain when breathing. The patient appears tachycardia and shortness of breath. Might start coughing up blood and fainting, there are signs of pleurisy.

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    Diagnosis of acute forms

    Acute pulmonary heart is diagnosed based on the symptoms, the results of x-ray and ECG. Conducted biochemical and General blood tests, blood tests for troponin-T and I, blood gas analysis, urine test.

    Also diagnosis of disease is done using angiography of the lungs, which is determined by the lesion and the distribution area of the process.

    Can also be used for: ventilation-perfusion scintigraphy of the lungs, cardiac catheterization with study pressure it right, MRI (magnetic resonance imaging).

    Легочное сердце: причины, лечение и прогноз

    How to recognize a chronic form of the disease?

    Chronic pulmonary heart in the initial stage of the disease is manifested the same symptoms as the underlying disease of the lungs. Over time, the signs associated with increased cardiac sections (right ventricle and right atrium):

  • Shortness of breath, aggravated by exertion. The deterioration it can appear at rest.
  • Cyanotic or pale gray skin, acrocyanosis: nose, feet, hands, tips of the ears, the lips become blue.
  • Swelling of veins of neck — they are tense and do not collapse as you breathe and exhale.
  • Cough, painful and lengthy. While separated, the rusty sputum is bloody or green-yellow, depending on the underlying disease.
  • At low load it is noted fatigue, weakness, drowsiness.
  • Pronounced apathy.
  • The decreased body temperature and hypotension.
  • Swelling.
  • Rare urination.
  • Nervous system disorders: depression, noise in the head, dizziness. This is due to the lack of oxygen in the blood.
  • Anasarca (edema of the whole body): develops due to fluid accumulation in the peritoneum and thoracic cavity due to the increase in swelling.
  • Erratic and rapid heartbeat. The reason for the development of this condition is that the enlarged heart cannot contract and pump the required volume of fluid.
  • Causes and diagnosis of chronic forms of the disease

    Chronic pulmonary heart can trigger the 3 group of diseases.

    To the first group include pathologies that affect the respiratory system. Is bronchial asthma, bronchitis, pneumoconiosis, fibrosis, cystic fibrosis, alveolar microlithiasis, Berlioz, hypoxemia, etc.

    The second group consists of the disease, leading to impaired ventilation due to changes in the mobility of the thorax. It’s a neuro-muscular disease chronic incorrect posture, deformation of the rib cage, Pickwick syndrome, thoracoplasty etc.

    To the third group belong the processes that affect the vessels of the lungs. Is a thrombosis of the lungs, periarteritis nodosa, pulmonary hypertension, aneurysms and tumors of the mediastinum, compressing the veins and pulmonary artery.

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    The chronic form of the disease is diagnosed on the basis of complaints of patient and anamnesis of disease. The patient shall be examined by a specialist who will detect a heart murmur, rales in the lungs, measure blood pressure. Mandatory diagnostic methods are: electrocardiography (ECG), echocardiography (EchoCG), x-ray light.

    Performed General biochemical blood tests, determination of blood gases, urine test.

    When conducting x-ray examination revealed signs of hypertension in the system of the pulmonary artery, increased volume of the right ventricle, enlargement of the superior Vena cava.

    Treatment of the disease

    Therapeutic measures are primarily directed to the treatment of major pulmonary diseases, prevention of exacerbations and treatment of respiratory failure.

    Symptomatic treatment is the use of mucolytics, bronchodilators, analeptics, oxygen. If pulmonary decompensated heart flows, shows the use of hormonal drugs (corticosteroids).

    Chronic pulmonary heart, which combined with high blood pressure, Aminophylline treated in the early stages, Nifedipine, in decompensated over — Nitroglycerin. This therapy is performed under the control of blood gases because there is danger of increasing hypoxemia.

    If signs of heart failure are used glycosides and diuretics. While taking such medicines should comply with the precautions as hypokalemia and hypoxia glycosides have a toxic effect on the myocardium.

    Treatment of hypokalemia carried drugs potassium (potassium Chloride, Panangin). Of diuretics should prefer funds that retains potassium in the body (Aldactone, Triampur).

    When symptoms of polycythemia are bleeding at 200-220 ml of blood injected into the vein of the solutions for infusion of low viscosity (Reopolyglukine, etc.).

    Treatment of patients with pulmonary heart also carried out using prostaglandins, endogenous vasodilators that possess antiproliferative, cytoprotective, anti-aggregating action.

    Of particular importance in the treatment of pulmonary heart disease play the antagonists of endothelin receptors. Bosentan is an endothelial vasoconstrictor, which increases in different forms of pulmonary heart disease. These drugs are used to decrease postnagruzki right ventricle and treatment of pulmonary hypertension.

    If developed acidosis, intravenous infusion to produce a solution of sodium Bicarbonate. To improve the metabolism of cardiac muscle in pulmonary heart, inflammation of the gums is assigned (internally to 0.25 g twice a day) and Asparkam or Potassium orotate.

    Additionally appointed LFK (physiotherapy exercises), breathing exercises, hyperbaric oxygenation, massage. To prevent the risk of blood clots, the patient must take blood thinners.

    Prevention and prognosis

    To prevent the development of pulmonary heart disease in the first place, is the prevention of lung diseases, and the incidence of the disease — early treatment. Autumn and winter people suffering from chronic lung disease, are advised to avoid contact with carriers of viral infection to prevent worsening of the disease.

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    If allergic, the patient is missing every fall recommended immunization with a polyvalent vaccine against influenza viruses. In severe bronchopulmonary disease in a patient at winter shows antibiotics (Ampicillin, Tetracycline, Erythromycin).

    Equally important for prevention of the disease is to avoid contact with substances irritating the mucous membrane of the bronchi. That is why the patient should stop Smoking. Also you should try to be less in an environment with high dust loading and to avoid the use of aerosols. It is not necessary to start the treatment of unproductive cough, irritating the respiratory tract.

    If a person is working in dusty conditions, it is recommended to reduce dust concentration to a safe or transferring him to another job. When working with hazardous substances are required to use the respirator.

    To facilitate expectoration and to improve the patency of the bronchi, we recommend drinking enough water (1.5 litres a day). More effectively removes sputum accumulated during the night, postural drainage with the prior inhalation of a bronchodilator. Recently, the treatment means mucolytic and expectorant preparations have no significant impact on the patency of the bronchi.

    If signs of disease do not delay the visit to a specialist. Timely diagnosis of the disease will help to reduce the risk of complications.

    The complications can be:

  • Fainting during exercise.
  • Peripheral edema.
  • Hemorrhoids.
  • Insufficiency of the tricuspid valve.
  • Acute pulmonary heart is often complicated by oedema of the lung, resulting in greatly increased the risk of death.
  • The lack of oxygen during exercise (hypoxia).
  • A stomach ulcer.
  • Peripheral venous insufficiency (varicose veins).
  • Cirrhosis of the liver.
  • If chronic pulmonary heart enters a phase of decompensation, the prognosis for the health, life expectancy and quality of life negative. Already in the early stages of the disease performance in patients with pulmonary heart dictates the need for a rational labour and the decision of a question on assignment of a disability group. Early treatment improves the prognosis of labor and increases life expectancy.

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