肺心病

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1、ChronicPulmonaryheartdisease1.DefinitionItisdirectlycausedbychronicalterationsinpulmonarycirculationorchronicchestdiseasesthatleadtopulmonaryarterialhypertension,rightventricularenlargement,evenrightheartfailure.2.EtiologyA.Bronchialandpulmonarydisorders：chronicbro

2、nchitiscomplicatedwithCOPD:80－90%asthma,bronchiectasis,tuberculosis,silicosis,chronicinterstitiallungdiseaseB.Disordersofchestmovement:（rare）abnormality,adhesion,vertebraltuberculosis、rhumatoidspondylitis。2.EtiologyC.DisordersofnerveandmusclePoliomyelitisdisorderso

3、fmotor-nervecenterD.DisordersofpulmonaryvesselsHypersensitvegranulomaembolismofpulmonaryarteryE.pulmonaryarterialhypertensionofunknowncause3.Pathology1).mainprimarydisordersoflungchronicbronchitisandemphysema2).changesofpulmonaryvesselsA.thewallofpulmonaryvesselst

4、hickening,narrowing,orobliterativeB.capillarybedofalveolarwalldamaged,decreasedC.vascularbedoflungcompressedtobeirregular3.Pathology3).changesoftheheartincreasedheartweighthypertrophyofrightventricleenlargementofrightventricle4.PathophysiologyandpathogenesisA.pulmo

5、naryarterialhypertension1).organicchangesofpulmonaryvesselsa.thickeningofthevesselsb.deteriorationofemphysemac.Decreasedcapillarybed:>70%2).functionalchangesofpulmonaryvesselsfactorsofbodyfluid,tissueandnerve3).remodelingofpulmonaryvesselsvasoconstrictionofv

6、esselshypertrophyofsmoothmusclecell4).increasedbloodvolumeandincreasedbloodviscosityhypoxiaRBCbloodviscosityresistanceofbloodflowLoadofrightventricleandhypertrophyofrightventricleearlystage:compensatedacuteexacerbation:incompetencycardiacoutputB.Changesofri

7、ghtheartfunctionC.ImpairmentoftheotherimportantorgansBrain,liver,kidneydigestivecanal,etal5.Clinicfindings1).compensatedstage(includeremittentstage)signs:cough,sputum,wheeze,exertionaldyspnea,edemaoflowlimb,exerciseintolerancephysicalexaminationdecreasedbreathsoun

8、ds,rhonchiormoistralesdistanceofthecardiacsoundP2>A2theupperborderoftheliver2).incompensatedstage(includeacuteexacerbation)respiratoryfailure(inducedbyinfection)hea