What Is Cor Pulmonale?

Pulmonary heart disease in the elderly is chronic pulmonary heart disease. It is caused by chronic lesions in the lung tissue, pulmonary arteries, or thorax, resulting in abnormal structure and function of the lung tissue, resulting in increased pulmonary vascular resistance and increased pulmonary artery pressure. Heart disease without right heart failure. The vast majority of patients with pulmonary heart disease in China occur on the basis of chronic bronchitis or emphysema.

Basic Information

nickname

Chronic pulmonary heart disease

English name

Pulmonary Heart Disease

Visiting department

Cardiology

Common locations

Heart, lungs

Common causes

COPD, tuberculosis, chronic lung infection, lung radiotherapy, thoracic deformity, sleep disordered breathing, pulmonary embolism, primary pulmonary hypertension, etc.

Common symptoms

Cough, expectoration, wheezing, palpitations after exercise, etc.

Contagious

Cough, expectoration, wheezing, palpitations, shortness of breath, fatigue after breathing, respiratory failure, heart failure, etc.

1. Chronic obstructive pulmonary disease (COPD)

COPD caused pulmonary heart disease accounted for 84.01%. It can be seen that COPD is the most important cause of elderly pulmonary heart disease.

2. Fibrotic lung disease

Including idiopathic pulmonary interstitial fibrosis and secondary pulmonary interstitial fibrosis, tuberculosis, pneumoconiosis, chronic lung infection, and lung radiation therapy are more common.

3. Diseases that affect respiratory movement

Such as severe thoracic deformity, thoracoplasty, severe pleural hypertrophy, obesity with insufficient pulmonary ventilation, sleep disordered breathing and so on.

4. Pulmonary vascular disease

Such as pulmonary embolism, primary pulmonary hypertension and so on.

1. Lung and heart function compensation period (including remission period)

This period is mainly the manifestation of chronic obstructive emphysema. May manifest as cough, sputum, wheezing, palpitations, shortness of breath, fatigue, and decreased labor endurance after exercise. It can also be manifested as symptoms of left heart failure such as cardiogenic asthma, sitting breathing, and acute pulmonary edema. Physical examination may have obvious signs of emphysema. Due to the increase of the pleural cavity pressure, the vena cava is prevented from flowing back, and the jugular vein is full. The appearance of the thorax is barrel-shaped, the breathing motion is weakened, the speech tremor is weakened, the respiratory sound is reduced, and the exhalation is prolonged. Sometimes, wheezing and wet sounds are heard at the bottom of the lung, heart dullness is reduced, heart sounds are distant, liver dullness is reduced, liver is accompanied by tenderness, hepatic jugular vein reflux, edema, and ascites are common. Lower extremity edema is common, and lower extremity edema occurs in the afternoon. Obviously, it disappeared the next morning. In addition, the pulmonary valve area may have a second heart sound, suggesting pulmonary hypertension. A systolic murmur in the tricuspid valve area or a beating heart under the xiphoid process may indicate right ventricular hypertrophy. Due to the decline of the radon, the upper and lower margins of the liver moved significantly downward.

2. Decompensation period of lung and heart function (including acute exacerbation period)

The clinical manifestations in this phase are mainly respiratory failure, with or without heart failure.

(1) Respiratory failure. Acute respiratory infections are common causes. Most of them are ventilatory obstructive respiratory failure (type II respiratory failure). Hypoxemia and hypercapnia coexist. The main manifestations of hypoxemia are chest tightness, palpitation, shortness of breath, headache, fatigue and abdominal distension. Significant cyanosis can occur when arterial oxygen saturation is below 90%. Severe hypoxia may cause restlessness, coma, or convulsions, and pulmonary encephalopathy may occur. The main manifestations of hypercapnia are skin hyperthermia, sweating, superficial vein dilation, flooding veins, conjunctival congestion and edema, pupil shrinkage, and even prominent eyeballs, fluttering tremors in both hands, dizziness, headache, lethargy, and coma.

(2) Heart failure Pulmonary heart disease has only signs of pulmonary hypertension and right ventricular hypertrophy during the functional compensation phase, but no heart failure manifestation. During decompensation, right heart failure, palpitation, shortness of breath, jugular vein distension, hepatomegaly, lower extremity edema, and even whole body edema and ascites are present. A few patients may also be accompanied by clinical manifestations of left heart failure and arrhythmia.

Arterial blood gas analysis

Hypoxemia or concomitant hypercapnia may occur during the pulmonary function compensatory period of pulmonary heart disease. When PaO250mmHg, this is more common in pulmonary disease caused by chronic obstructive pulmonary disease.

Blood test

The red blood cell count and hemoglobin can be increased, and the hematocrit can be as high as 50% or more. Whole blood viscosity and plasma viscosity can be increased. Erythrocyte electrophoresis time is often prolonged. When co-infection occurs, the total number of white blood cells increases, neutrophils increase, and nuclear left shift can occur. Serological examination of some patients may have changes in renal or liver function, as well as changes in high potassium, low sodium, low chlorine, low calcium, and low magnesium.

3. Lung function test

Significant for patients with early or remission pulmonary heart disease.

4.X-ray inspection

In addition to the characteristics of basic diseases of the lung and chest and acute lung infections such as enhanced lung light transmittance, widened intercostal space, and thickened disorder of the lung texture, there may still be pulmonary hypertension signs.

5. ECG examination

The main manifestations are changes in right atrium and ventricular hypertrophy, such as right axis deviation, average frontal axis + 90 °, severe clockwise indexing (V5R / S1), Rv1 + Sv51.05mV, aVR showed QR type and lung type P wave. The right bundle branch block and low-voltage pattern can also be seen, which can be used as a reference condition for the diagnosis of pulmonary heart disease.

6. ECG vector map check

Mainly as the right atrium, right ventricular hypertrophy.

7. Echocardiography

By measuring the inner diameter of the right ventricular outflow tract (30mm), the diameter of the right ventricle (20mm), the thickness of the anterior wall of the right ventricle (5mm), the ratio of the diameters of the left and right ventricles (<2.0), the inner diameter of the right pulmonary artery or the trunk of the pulmonary artery and Right atrial hypertrophy and other indicators to diagnose pulmonary heart disease.

8. Pulmonary impedance blood flow map and differential map examination

Analysis of the rise time, amplitude, wave area, and maximum rise speed of the pulmonary impedance blood flow chart can reflect the filling intensity of the blood flow in the pulmonary blood vessels and the time it takes. In pulmonary heart disease, the amplitude of the pulmonary impedance blood flow diagram and its differential wave value are often reduced, the QB (pre-ventricular ejection period) time is prolonged, the BY (right ventricular ejection period) time is shortened, and the QB / BY ratio is increased. Cardiac disease has a reference significance, and has a significant correlation with the prediction of pulmonary arterial pressure and the prediction of hidden pulmonary hypertension after exercise, and has certain reference value.

According to medical history and physical symptoms, relevant examinations have confirmed pulmonary hypertension or right ventricular hypertrophy; the decompensation period is mainly respiratory failure and right heart failure, which can diagnose elderly pulmonary heart disease.

Patients with chronic pulmonary heart disease are often accompanied by multi-system, multi-organ damage and failure, which can lead to death if not rescued in time. Therefore, in the treatment of pulmonary heart disease, in addition to treating basic chest and lung diseases and improving pulmonary heart function, it is necessary to maintain the functions of various system organs and take active measures to treat them.

1. Actively control lung infections

Pulmonary infection is the most common cause of acute exacerbation of pulmonary heart disease. Active control of pulmonary infection can improve the condition.

2. Open airway

During acute exacerbation of pulmonary heart disease, patients with mucosal congestion and edema due to inflammation in the airways, increased glandular secretion, and poor drainage of sputum make the airway obstruction further worse. In order to improve the ventilation function, the oropharyngeal secretions should be removed first to prevent the gastric contents from flowing back to the trachea and encourage a strong cough to expel sputum. For those who are chronically weak and unable to sputum, gently pat the back of the patient to assist in expectoration when coughing. Such as severe insufficient ventilation, unconsciousness, cough reflex, and thick sputum and cough can not cough up the respiratory tract, should be established in time, regular suction through the tracheal tube. Encourage patients to drink more water to correct dehydration and humidify airways and sputum. In addition, mucolytic agents and expectorants can be applied. The commonly used drugs are acetylcysteine and bromhexine. At the same time, drugs that improve bronchial dilation to improve ventilation, such as: bronchodilators, selective 2 receptor stimulants and theophylline drugs. Eliminate non-specific airway inflammation, corticosteroids can enhance the effect of 2 receptor stimulants by adenylate cyclase, relax the bronchi, and can also block or inhibit the synthesis and release of certain inflammatory mediators, thereby reducing the inflammatory response. Prednisone is commonly used as an oral medication, and beclometasone (biscodone) is used for inhalation. The dosage of corticosteroids should be different from person to person, and the dosage should not be too large, so as not to cause adverse consequences.

3. Correct hypoxia and carbon dioxide retention

(1) Oxygen therapy is to increase the inhaled oxygen concentration, thereby increasing the partial pressure of oxygen in the alveoli, increasing the partial pressure of oxygen in the arteries and the oxygen saturation of the blood, reducing the work of the respiratory muscles and pulmonary hypertension, and reducing the right heart load. In addition, inhaling high concentrations of O2 relieves hypoxic pulmonary vasoconstriction and redistributes blood flow in the lungs. Oxygen therapy can be performed using a dual-lumen nasal tube, nasal cannula or mask for oxygen inhalation. Improved, slowed heart rate, and unconsciousness, you can continue to give oxygen.

(2) Respiratory stimulants should have good indications when clinically using respiratory stimulants. If patients with low ventilation are mainly centrally inhibited, patients with pulmonary heart disease and respiratory failure who have a low level of conscious disturbance and unobstructed airway will have better curative effects. For severe bronchospasm, poor drainage of sputum, and ventilation dysfunction caused by pneumonia, pulmonary edema, and extensive interstitial fibrosis of the lung as the main lesions, respiratory stimulants have disadvantages and disadvantages and should not be used. Respiratory stimulants include nicolaza (colamin), lobelin, doxapram, Duxil, etc.

(3) Mechanical ventilation For patients with severe respiratory failure, early mechanical ventilation should be performed.

4. Correct acid-base imbalances and electrolyte disorders

The acute exacerbation of pulmonary heart disease is prone to acid-base imbalances and electrolyte disorders. The common types of acid-base imbalances are respiratory acidosis, respiratory acidosis combined with metabolic acidosis or metabolic alkalosis, and the treatment of respiratory acidosis is the key. To improve ventilation, when respiratory acidosis is combined with metabolic acidosis, the pH is significantly reduced. When the pH is less than 7.2, in addition to paying attention to improving ventilation, you should also appropriately drip sodium bicarbonate solution according to the situation. Observe and observe breathing while treating. Acidosis combined with metabolic alkalosis is mostly related to hypokalemia and hypochloremia, and treatment should be supplemented with potassium chloride; those with obvious alkalemia can also use acetazolamide (acetazamide) or hydrochloric acid as appropriate. Treatment. In addition, critical acid patients may have a triple acid-base imbalance, which should be detected and treated in time. Electrolyte disorders should be continuously monitored for targeted treatment.

5. Reduce pulmonary arterial pressure

Effective oxygen therapy is probably the most important measure to reduce pulmonary arterial pressure. There are currently no drugs that selectively reduce pulmonary arterial pressure. Phentolamine and nifedipine (nifedipine) have certain effects. Pay attention to blood pressure and cardiac response when applying.

6. Control Heart Failure

Pulmonary heart disease patients generally can improve heart failure after actively controlling infection and improving respiratory function. But for patients who are ineffective or heavier after treatment, diuretics, positive inotropic drugs or vasodilators can be appropriately selected.

7. Management of cerebral edema

Pulmonary heart disease patients often have pulmonary encephalopathy due to severe hypoxemia and hypercapnia, and clinical manifestations of neuropsychiatric symptoms and intracranial hypertension cerebral edema. Therefore, in addition to the above-mentioned treatment of pulmonary heart disease, intracranial pressure should be reduced as soon as possible, cerebral edema should be reduced, and neuropsychiatric symptoms should be controlled.

8. Strengthen nursing work

Because the condition is complex and changeable, it is necessary to closely observe the change of the condition, and it is appropriate to strengthen the monitoring of cardiopulmonary function. Turning over and patting the back to eliminate respiratory secretions is an effective measure to improve ventilation.