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Pulmonary heart is understood as a clinical syndrome caused by hypertrophy and (or) dilatation of the right ventricle resulting from hypertension in the pulmonary circulation, which in turn develops as a result of bronchial and pulmonary disease, chest deformity, or pulmonary vascular disease.
The main clinical manifestations
Complaints of the patient are determined by the underlying disease, complicated by pulmonary heart, as well as severe respiratory failure. The clinical picture of the compensated and decompensated pulmonary heart is different. Decisive for the diagnosis of compensated pulmonary heart are additional studies to objectify hypertrophy of the right heart by instrumental examination of the patient. With decompensated pulmonary heart, dyspnea becomes constant. The respiratory rate increases, but the exhalation does not increase. After coughing, the intensity and duration of shortness of breath increase. Fatigue progresses, disability is reduced, drowsiness, headache (as a result of hypoxia and hypocapnia) are noted. Patients complain of pain in the region of the heart due to metabolic disturbances in the myocardium, its hemodynamic overload, due to insufficient development of collaterals in a hypertrophic myocardium. Pain is sometimes combined with severe suffocation, agitation, sharp general cyanosis - this is characteristic of hypertensive crises in the pulmonary artery system. Complaints of edema, heaviness in the right hypochondrium, an increase in the abdomen with an appropriate (most often chronic) pulmonary history make it possible to suspect a pulmonary heart in the decompensation phase. Objectively: swollen cervical veins, diffuse cyanosis, edema of the lower extremities. With the development of a complication of COPD, such as amyloidosis, edema can also occur. Tachycardia is noted, and at rest it is more pronounced than with exercise; epigastric pulsation due to hypertrophied right ventricle. Possible increase in blood pressure due to hypoxia. The liver is enlarged. Of the additional studies, chest x-ray is informative (to reveal an increase in the right heart and pulmonary artery pathology); ECG; blood test - erythrocytosis, increased hematocrit, increased blood viscosity.
B.E. Votchal (1964) proposes to classify the pulmonary heart according to four main features: 1) the nature of the course, 2) the state of compensation, 3) the predominant pathogenesis, 4) the characteristics of the clinical picture.
Table 1. Classification (according to B.E. Votchal) There are acute, subacute and chronic pulmonary hearts, and the rate of development of pulmonary hypertension is decisive. In acute pulmonary heart, pulmonary hypertension occurs within a few hours or days, in subacute - several weeks or months, in chronic - several years. Acute pulmonary heart most often (about 90% of cases) is observed with pulmonary embolism or a sudden increase in intrathoracic pressure, subacute - with cancer lymphangitis, thoracodiaphragmatic lesions.
Chronic pulmonary heart in 80% of cases occurs with damage to the bronchopulmonary apparatus (moreover, in 90% of patients due to chronic non-specific lung diseases).
Compensated pulmonary heart. There are no subjective specific signs of the disease. Objectively, you can identify a direct clinical sign of right ventricular hypertrophy - an enhanced spilled heart beat defined in the precardial or epigastric region.
Auscultatory data characteristic of compensated pulmonary heart, no. However, the assumption of pulmonary hypertension becomes more likely when an accent or splitting of II tone over the pulmonary artery is detected. A sign of compensated pulmonary heart is also considered a loud I tone above the tricuspid valve compared with I tone above the apex of the heart. The significance of these auscultatory signs is relative, since they may be absent in patients with severe emphysema.
For diagnosis, instrumental methods such as spirography, X-ray diffraction, electrocardiography, phonocardiography are used. The most reliable way to detect pulmonary hypertension is to measure pressure in the right ventricle and pulmonary artery using a catheter (at rest in healthy people, the upper limit of normal systolic pressure in the pulmonary artery is 25-30 mm Hg). However, this method cannot be recommended as the main one, since it is used only in a specialized hospital. Normal indicators of resting systolic pressure do not exclude the diagnosis of pulmonary heart.
Uncompensated pulmonary heart. Its diagnosis, if circulatory failure reaches stage IIB - III, in most cases is simple. It is difficult to diagnose the initial stages of circulatory failure, since the early symptom of heart failure - shortness of breath - cannot be the main one, since it exists in patients with NHL as a sign of respiratory failure long before the development of circulatory failure.
So, when making a diagnosis of compensated pulmonary heart, it is crucial to identify hypertrophy of the right heart (ventricle and atrium) and pulmonary hypertension; In the dynamics of decompensated pulmonary heart, the identification of the symptoms of right ventricular heart failure is of primary importance.
1. Bronchiectatic disease, stage of expressed clinical manifestations, pulmonary insufficiency of the II degree, pulmonary heart, chronic, compensated.
2. Chronic pneumonia, bronchiectasis, pulmonary insufficiency of the II degree, pulmonary heart, decompensated, chronic circulatory failure, stage II, phase B (KNK II st. F. B)
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- 52. LUNG HEART. ETHIOLOGY, PATHOGENESIS OF ACUTE AND SUBCUTANEOUS, CHRONIC PULMONARY HEART, CLINIC, DIAGNOSTIC, TREATMENT PRINCIPLES.
Pulmonary sero-pathological condition, characterized by hypertrophy of the right ventricle caused by hypertension of the pulmonary circulation, which develops with damage to the bronchopulmonary apparatus, pulmonary vessels, chest deformity, or other diseases that impair lung function. Acute heart lay-wedge symptom complex arising from pulmonary artery thromboembolism, and with
- Pulmonary heart and pulmonary circulation disorders
ICD code: (126-128) 126 Pulmonary embolism 126.0 Pulmonary embolism with reference to acute pulmonary heart 126.9 Pulmonary embolism without mention of acute pulmonary heart 127 Other forms of pulmonary heart failure 127.0 Primary pulmonary hypertension 127.1 Kyphoscoliotic heart disease 127.8 Other specified forms of pulmonary heart failure 127.9
- Heart diseases. Coronary heart disease (CHD). Reperfusion syndrome. Hypertensive heart disease. Acute and chronic pulmonary heart.
1. IHD is 1. productive myocarditis 2. myocardial fatty degeneration 3. right ventricular failure 4. absolute coronary circulatory failure 5. relative coronary insufficiency 2. Forms of acute coronary heart disease 1. myocardial infarction 2. cardiomyopathy 3. angina pectoris 4. exudative myocarditis 5 sudden coronary death 3. With angina pectoris in cardiomyocytes
- HEART DISEASES. CORONARY ARTERY DISEASE. HYPERTENSIVE HEART DISEASE. Myocardial hypertrophy. ACUTE AND CHRONIC PULMONARY HEART
HEART DISEASES. CORONARY ARTERY DISEASE. HYPERTENSIVE HEART DISEASE. Myocardial hypertrophy. ACUTE AND CHRONIC PULMONARY
- PULMONARY HEART
Alfred P. Fishman (Alfred P. Fishman) Under the pulmonary heart understand the increase in the right ventricle due to impaired lung function. However, impaired lung function does not always occur due to a disease of the lungs proper: in some cases, the cause is chest deformity or inhibition of the respiratory impulse from the respiratory center (Table 191-1). In those
- CHRONIC PULMONARY HEART
Chronic pulmonary heart refers to hypertrophy of the right ventricle against a background of a disease that affects the function or structure of the lungs, or both at the same time, except when these pulmonary changes are the result of damage to the left heart or congenital heart defects. More commonly associated with chronic bronchitis, emphysema, bronchial asthma, pulmonary fibrosis
- Pulmonary heart
PULMONARY HEART (LS) is a clinical syndrome caused by hypertrophy and / or dilatation of the right ventricle resulting from hypertension in the pulmonary circulation, which in turn develops as a result of diseases of the bronchi and lungs, chest deformity, or damage to the pulmonary vessels. Classification. B.E. Votchal (1964) proposes to classify the pulmonary heart by 4
- Pulmonary heart
Signs and symptoms of pulmonary heart • Dyspnea. • ???? When straining - loss of consciousness. • ???? Accent II tone over the pulmonary artery. • ???? The appearance of wave A on the pressure curve of the right atrium during its invasive registration. • ???? The presence of signs of left ventricular failure. 18.104.22.168. Preoperative preparation in patients with pulmonary heart • ???? Elimination of pulmonary infection
- Pulmonary (right ventricular) hypertensive heart disease
(pulmonary heart, cor pulmonale) can be acute and chronic. Acute pulmonary heart develops with massive thromboembolism into the pulmonary artery system and is manifested by acute dilatation of the right ventricle (and then the right atrium) and acute right ventricular failure. Chronic pulmonary heart is distinguished by working concentric hypertrophy of the right ventricle (reaching thickness
- 1.4. CHRONIC PULMONARY HEART (HLC)
The treatment of patients with HFS should be comprehensive and aimed at reducing pressure in the pulmonary artery (LA), improving bronchial patency and alveolar ventilation, eliminating pulmonary and heart failure, which can be achieved with adequate therapy for the underlying disease that led to the onset of HFS. 1. Bronchodilators - selective short-acting beta2-adrenostimulants
- Indirect heart massage combined with artificial respiration (cardiopulmonary resuscitation)
This complex procedure is used in animals with circulatory disorders and respiratory arrest (with sun and heat stroke, anaphylactic shock, electric shock, carbon monoxide and exhaust poisoning, with a diabetic crisis, acute heart failure, and other cases where heart failure can occur. B the basis of artificial respiration
- CHRONICAL BRONCHITIS. CHRONIC PULMONARY HEART.
In recent years, due to the deteriorating environmental situation, the prevalence of smoking, and a change in the reactivity of the human body, there has been a significant increase in the incidence of chronic non-specific lung diseases (COPD). The term KNZL was adopted in 1958 in London at a symposium convened by the pharmaceutical group Ciba. He combined such diffuse diseases
- 19. HEART TONES (CHARACTERISTIC OF I, II TONS, PLACE OF LISTENING). RULES OF AUSCULTATION. PROJECTION OF HEART VALVES ON THE BREAST CELL. HEART VALVE LISTENING POINTS. PHYSIOLOGICAL CHANGE OF HEART TONES. DIAGNOSTIC VALUE
The projection of heart valves on the anterior chest wall: 1) a bicuspid valve (mitral) is projected to the left at the sternum at the level of cartilage of the 4th rib; 2) the tricuspid valve is projected onto the middle of the line connecting the III costal cartilage on the left and the V costal cartilage on the right; 3) aortic valves are projected onto the middle of the sternum at level III of the costal cartilage; 4) pulmonary valve valves are projected onto III