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Pulmonary heart - Causes, symptoms and treatment. MF.

  • Pulmonary heart - Causes, symptoms and treatment. MF.

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    Pulmonary heart - thickening of the wall and expansion of the right atrium and right ventricle of the heart, which develop as a result of increased pressure in the small circulation as a result of bronchopulmonary pathology, pulmonary vascular lesions or chest changes.

    Causes of pulmonary heart

    It is accepted to distinguish acute, subacute, chronic pulmonary heart. With , the acute pulmonary heart , the symptoms of the disease grow over a number of hours, days and are based most often:

    1. Vascular damage:
    - pulmonary artery thromboembolism( PE) or its branches,
    - pneumomediastinum.
    2. Bronchopulmonary diseases:
    is a severe paroxysm of bronchial asthma with the development of asthmatic status,
    is extensive pneumonia.

    The development of subacute pulmonary heart requires several weeks or months. The reason for its occurrence can be:

    1. vascular lesions:
    - repeating microembolism medium-sized branches of the pulmonary artery,
    - pulmonary vasculitis,
    - primary pulmonary hypertension,

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    2. bronchopulmonary diseases:
    - diffuse fibrosing alveolitis,
    - oncological processes in the mediastinum, the so-called lymphogenic lung carciromatosis( distant metastases of the malignant neoplasms of the stomach, prostate, urinary system, etc.),
    - severe bronchial asthma,

    3. Thoraco diaphragmatic pathology:
    - alveolar hyperventilation with botulism, poliomyelitis, myasthenia gravis.

    The chronic pulmonary heart develops over several years. Causes -

    1. Vascular damage:
    - primary pulmonary hypertension,
    - arteritis,
    - recurrent embolism,
    - removal of part or all of the lung,

    2. Bronchopulmonary diseases:
    - obstructive bronchial diseases( emphysema, bronchial asthma, chronicbronchitis, pneumosclerosis),
    - restrictive processes,
    - fibrosis and granulomatosis,
    - multiple cystic formations in the lungs,

    3. Thoraco diaphragmatic pathology:
    - lesions of the thorax and spineand with deformation,
    - pleural adhesions,
    - obesity caused by various diseases.

    Symptoms of pulmonary heart

    When acute pulmonary heart , patients' complaints are reduced to the appearance of severe pain in the chest, rapidly developing severe dyspnea, widespread cyanosis, swelling of the cervical veins, a sharp drop in blood pressure, a pulse rate of more than 100 beats per minute. Possible pain in the right upper quadrant due to a sharp stretching of the liver capsule, nausea, vomiting.

    With subacute pulmonary heart , the same manifestations of the disease do not appear lightning-fast, but are somewhat stretched in time.

    Symptoms of of the chronic pulmonary heart before decompensation may be due to a major bronchopulmonary disease for a long time. The earliest patients noted an increase in heart rate, increased fatigue at normal load. Gradually, shortness of breath increases. If at the I degree of the disease shortness of breath appears only with considerable physical exertion, then to the third degree it disturbs the patients even at rest. Often patients report a rapid heartbeat. Pain in the heart area can be intense and pass after inhalation of oxygen. There is no clear relationship between the occurrence of pain and physical exertion, taking nitroglycerin does not relieve the painful attack. To the widespread cyanosis joins the purple-cyanotic coloring of the skin of the nasolabial triangle, lips, ears. Perhaps the swelling of the cervical veins, the appearance of edema on the lower limbs, and in severe cases develops ascites( fluid in the abdominal cavity).

    Examination of

    In addition to the patient's complaints, the objective survey data( increasing the transverse size of the heart, widening the heart boundaries to the right of the sternum, the appearance of specific noises in listening to the heart, soreness in the right hypochondrium with pressure, enlarging the liver, etc.)and the presence in the past of bronchopulmonary disease. To confirm the diagnosis, a number of diagnostic procedures are performed, listed below.

    Laboratory and instrumental examination.

    1. The general analysis of blood( UAC) - it is possible erythrocytosis( increase in the number of red blood cells), increased hemoglobin, slowing of ESR, increased blood clotting capacity in a chronic pulmonary heart.

    2. The general analysis of urine( OAM) is conducted as part of a general clinical examination.3. Biochemical blood test( BAC): pay attention to the content of total protein, protein fractions, sialic acids, fibrinogen, seromucoid.

    4. Immunoenzyme method - increased content of D-dimer in blood plasma for pulmonary embolism of pulmonary arteries.

    5. ECG - signs of a change and increase in the mass of the right atrium and right ventricle, changes in the position of the electric axis of the heart;

    6. Echocardiography( Echocardiography, or ultrasound of the heart) provides an opportunity to visually identify the dilated right atrium and right ventricle of the heart, reveals signs of increased pressure in the pulmonary artery and quantifies the degree of pulmonary hypertension, assesses the state of central hemodynamics.

    7. Radiography of the heart and lungs - an increase in the right atrium and ventricle, an increase in the distance between the branches of the pulmonary artery, an increase in the size of the descending branch of the pulmonary artery.

    8. Spirography - the manifestations of the underlying disease that caused the pulmonary heart are diagnosed.

    9. Selective angiopulmonography( contrasting pulmonary arteries using X-ray endovascular techniques) is one of the most informative methods in the diagnosis of an acute pulmonary heart that has developed as a result of pulmonary embolism.

    10. X-ray contrast study of the veins of the lower extremities - the method allows to detect thromboses in the veins of the lower extremities.

    Treatment with a pulmonary heart

    Self-medication and the use of traditional medicine with the appearance of signs of the pulmonary heart at best will be ineffective, and at worst - the patient will miss valuable time.

    In acute pulmonary heart treatment is reduced to resuscitation, restoration of permeability of pulmonary vessels and the fight against pain syndrome. Thrombolytic therapy is advisable to be carried out in the first 4-6 hours from the onset of the disease with massive thromboembolism of the pulmonary artery, its use in later terms of the disease may be unreasonable. Thrombolytic therapy is performed in the hospital only if there is the possibility of laboratory monitoring of the treatment and the absence of contraindications from the patient( recent injuries, peptic ulcer in the acute stage, a recent stroke, etc.).

    With all modern advances in medicine, treatment of the pulmonary heart remains a challenge and is aimed at slowing the progression of the disease, increasing life expectancy, improving the quality of life. An integrated approach in the treatment of pulmonary heart includes: treatment of the underlying disease or its exacerbations, relief of respiratory failure and gas exchange disorders, elimination or reduction of symptoms of heart failure in decompensation.

    Given the underlying pathology leading to the development of the pulmonary heart, appropriate treatment is prescribed: for various bronchopulmonary infections, antibiotics are prescribed, with bronchial obstruction, drugs that dilate the bronchi, with thrombosis or thromboembolism of pulmonary vessels, anticoagulants and fibrinolytics. In the treatment of the pulmonary heart, it is necessary to prescribe drugs that dilate peripheral vessels, diuretics, drugs that reduce blood clotting capacity, cardiac glycosides, and in the ineffectiveness of these drugs, small doses of glucocorticosteroids are prescribed.

    Almost all patients need oxygen inhalation. Of great importance is the rejection of harmful habits( smoking), the elimination of industrial hazards, the identification and removal of allergens from the body, the cessation of its further ingestion into the body, etc. The respiratory gymnastics and chest massage have definite significance in the complex treatment of patients with pulmonary heart. If the patient suffers from chronic inflammatory diseases of the respiratory system, then it is necessary to teach him methods of positional drainage of the bronchi.

    Than a symptom of the pulmonary heart

    Chronic pulmonary heart is a natural result of long and seriously leaking diseases of the bronchopulmonary apparatus, which leads to a decrease in the ability to work, a decrease in the quality of their life, disability of the patients, and eventually a fatal outcome.

    To which doctor should be treated with symptoms of pulmonary heart

    Therapist, pulmonologist, cardiologist.

    Physician therapist Kletkina Yu. V.