Internal illnesses. Chronic cor pulmonale (most important)

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Internal illnesses. Chronic cor pulmonale (most important)

Lecture notes, cheat sheets

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41. CHRONIC PULMONARY HEART

Hypertrophy and (or) dilatation of the right heart due to pulmonary arterial hypertension due to a respiratory disease.

Etiology. Bronchopulmonary disorders - obstructive and restrictive processes: polycystic pulmonary disease, chronic bronchitis, bronchial asthma, pulmonary emphysema, diffuse pneumofibrosis, pulmonary granulomatosis. Vascular lesions - primary pulmonary arterial hypertension, arteritis, repeated pulmonary embolisms, lung resections, damage to the thoracodiaphragmatic apparatus. Lesions of the spine, chest, their deformation, pleural cords, obesity.

Pathogenesis. Pathogenetic stages: precapillary hypertension in the pulmonary circulation, right ventricular hypertrophy, right ventricular heart failure, development of pulmonary arterial hypertension, increase in cardiac output due to increased catecholamines caused by hypoxia, increased blood viscosity due to erythrocytosis in response to chronic hypoxia, development of bronchopulmonary anastomoses, increased intraalveolar pressure in broncho-obstructive pulmonary diseases.

Clinic. The main manifestations are the following: shortness of breath, cyanosis (appears with II and III degrees of respiratory failure), swelling of the jugular veins, epigastric pulsation, tachycardia, expansion of the boundaries of the heart, especially to the right, deafness of heart tones, emphasis of the II tone over the pulmonary artery, enlargement and tenderness of the liver , peripheral edema, small diuresis (in a decompensated state).

Diagnostic research. A general blood test, a study of a general urinalysis (the appearance of protein, cylinders during decompensation), a biochemical blood test (dysproteinemia), and a functional study of the lungs are carried out.

On the ECG - signs of cor pulmonale: high P waves in the II and III standard leads (P - pulmonale), rightogram, pronounced S wave in the I standard lead and left chest leads, the appearance of Q in the III lead.

A study of hemodynamics is carried out (increased central venous pressure, slowing down the speed of blood flow, increasing the volume of circulating blood).

On EchoCG: an increase in thickness in a compensated state and an increase in the cavity in a decompensated state of the right ventricle. An X-ray examination is also performed.

Treatment. Treatment is aimed at treating the underlying disease. For infection of the bronchopulmonary apparatus, antibiotics are used, for bronchial obstruction - bronchodilators, for pulmonary embolism - anticoagulants, fibrinolytic drugs, for thoradiaphragmatic cor pulmonale - artificial ventilation. Peripheral vasodilators are used to reduce pulmonary arterial hypertension (nitrates, apressin, calcium channel blockers, beta-agonists). Oxygen therapy, bloodletting of 2-200 ml with infusion of low-viscosity solutions (reopolyglucin) to reduce erythrocytosis, and infusion of sodium bicarbonate solution to reduce acidosis are carried out.

Flow. The course of the disease is chronic and progressive.

Forecast. Adverse.

Author: Myshkina A.K.

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