内科学_肺心病

B. Changes of right heart function
Load of right ventricle and hypertrophy of right ventricle early stage: compensated acute exacerbation :incompetency cardiac output
respiratory failure ( induced by infection) heart failure
ቤተ መጻሕፍቲ ባይዱ
Pathology
3). changes of the heart increased heart weight
hypertrophy of right ventricle enlargement of right ventricle
pathogenesis
A. pulmonary arterial hypertension
Epidemiology
70 years morbidity >40y 0.46% 90 years morbidity > 15y 0.70％，
county>city
north > south
male>female smoke>no smoke
agedness>young 51－60>41—50 high 2－3倍
2. Disorders of chest movement: （ rare ）
abnormality,adhesion, vertebral tuberculosis、 rheumatoid spondylitis 。
Etiology
3. Disorders of pulmonary vessel:
b. factors of tissue c. factors of d nerve。
3). remodeling of pulmonary vessels vasoconstriction of vessels hypertrophy of smooth muscle cell
4). increased blood volume and increased blood viscosity hypoxia RBC blood viscosity resistance of blood flow
pulmonary arterial hypertension of unknown cause Hypersensitive granuloma embolism of pulmonary artery 4. other: Disorders of nerve and muscle
Poliomyelitis disorders of motor-nerve center
Chronic Pulmonary heart disease
Chronic Pulmonary heart disease
Definition
It is directly caused by chronic alterations in
pulmonary circulation or chronic chest diseases that lead to pulmonary arterial hypertension, right ventricular enlargement, even right heart failure.
Different cardiopathy in hospital 5～35％
Etiology
1. Bronchial and pulmonary disorders：
chronic bronchitis complicated with COPD: 80－90%
asthma, bronchiectasis, tuberculosis, silicosis, chronic interstitial lung disease
1). organic changes of pulmonary vessels
a. thickening of the vessels b. deterioration of emphysema
2). functional changes of pulmonary vessels
a.factors of body fluid:5-HT、At-II、LTs、 TXA2 、PGF2 、PGE1、PGI2。
C. Impairment of the other important organs
Brain, liver, kidney digestive canal, et al
Clinic findings
1).compensated stage(include remittent stage) signs: cough, sputum, wheeze, exertional dyspnea,
edema of low limb, exercise intolerance
physical examination
decreased breath sounds, rhonchi or moist rales distance of the cardiac sound P2>A2
the upper border of the liver 2).incompensated stage(include acute exacerbation)
Pathology
1). main primary disorders of lung chronic bronchitis and emphysema
2). changes of pulmonary vessels A. the wall of pulmonary vessels thickening, narrowing, or obliterative B. capillary bed of alveolar wall damaged , decreased C. vascular bed of lung compressed to be irregular