肺心病英文中山大学内科学

Mechanism and Pathology
（一）Pulmonary hypertension：
Definition ：mean pulmonary artery pressure （mPAP）
≥ 25 mmHg at rest or 来自百度文库 30 mmHg during exercise.
Functional changes in pulmonary vascular
Clinical Manifestations
Decompensation stage of cardiac and lung function
Respiratory failure
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Symtoms: severe dyspnea,especially at night, headache, insomnia,inappetence, somnolence, dizziness,confusion, even delirium. Signs: conjunctiva congestion and edema, retinal vasodilatation, optic papillary edema; weakness or disappear of deep reflexes, pathological reflexes.
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Clinical Manifestations
Decompensation stage of cardiac and lung function
Right heart failure
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Symtoms: dyspnea aggravated, palpitation, inappetence, abdominal distention,nausea.
Pulmonary hypertension → Afterload of right ventricular ↑, Oxygen supply of myocardium ↓ → Hypertrophy and dilatation of the right ventricle → Right heart failure
Signs: cyanosis, arrhythmia, tachycardia,subxiphoid systolic murmur or even diastolic murmur. Tender hepatomegaly, Hepatojugular reflux, lower extremity edema, ascites.
• Hypoxia, Hypercapnia, Respiratory acidosis, vasoconstriction substances→Pulmonary vasoconstriction→Pulmonary hypertension • Hypoxia is the most important factor leads to pulmonary hypertension
Chronic Pulmonary Heart Disease
The second affiliated hospital of Sun Yat-sen
university, pulmonary department.
Shanping Jiang
OUTLINE
Definition ： Chronic lung,chest or pulmonary vascular diseases→Pulmonary vascular resistance ↑ → Pulmonary artery pressure↑ → Hypertrophy and dilatation of the right ventricle →Right Heart Failure Prevalence：0.44%～0.46% Onset ages：＞40 years old Incidence season：Winter and Spring Predisposing factors ：Acute respiratory infections
Anatomic changes in pulmonary vascular
• Remodeling of pulmonary vessels
Increased blood viscosity and blood volume
Mechanism and Pathology
（二）Dysfunction of right heart
Etiology
Chronic bronchial and lung diseases：the most common disease is Chronic obstructive pulmonary disease ＞80% Thoracic deformity Pulmonary vascular disorders Others
(三）Damages to other vital organs：
Multiple organ dysfunction
Clinical Manifestations
Compensation stage of cardiac and lung function
• Symptoms: cough, sputum, short of breath; dyspnea and palpitation on exertion; fatigue and decrease of exercise tolerance;exacerbated by acute infection. • Signs: cyanosis, signs of emphysema, moist rales and/or rhonchi; P2>A2 , systolic murmur of tricuspid area, subxiphoid visible/palpable cardiac impulse, distended jugular venous.