Pulmonary heart – the pathology of the right departments of heart which is characterized by increase (hypertrophy) and expansion (dilatation) of the right auricle and ventricle, and also the insufficiency of blood circulation developing owing to hypertensia of a small circle of blood circulation. Formation of pulmonary heart is promoted by pathological processes of bronchopulmonary system, vessels of lungs, a thorax. Short wind, zagrudinny pains, increase of skin cyanosis and tachycardia, psychomotor excitement, a gepatomegaliya belong to clinical manifestations of sharp pulmonary heart. Inspection reveals increase in borders of heart to the right, a gallop rhythm, a pathological pulsation, signs of an overload of the right departments of heart on the ECG. Carry in addition out a X-ray analysis of bodies of a thorax, ultrasonography of heart, research FVD, the analysis of gas composition of blood.
Pulmonary heart – the pathology of the right departments of heart which is characterized by increase (hypertrophy) and expansion (dilatation) of the right auricle and ventricle, and also the insufficiency of blood circulation developing owing to hypertensia of a small circle of blood circulation. Formation of pulmonary heart is promoted by pathological processes of bronchopulmonary system, vessels of lungs, a thorax.
The sharp shape of pulmonary heart develops quickly, in several minutes, hours or days; chronic – for several months or years. Almost at 3% of patients with chronic bronchopulmonary diseases pulmonary heart gradually develops. Pulmonary heart considerably burdens the course of cardiopathologies, taking the 4th place among the lethality reasons at cardiovascular diseases.
Reasons of development of pulmonary heart
The bronchopulmonary shape of pulmonary heart develops at primary damages of bronchial tubes and lungs as a result of chronic obstructive bronchitis, bronchial asthma, a bronkhiolit, emphysema of lungs, a diffusion pneumosclerosis of various genesis, a polikistoz of lungs, bronkhoektaz, tuberculosis, a sarkoidoz, a pneumoconiosis, Hammen's syndrome - Rich, etc. About 70 bronchopulmonary diseases promoting formation of pulmonary heart in 80% of cases can cause this form.
Emergence of a torakodiafragmalny shape of pulmonary heart is promoted by primary damages of a thorax, a diaphragm, restriction of their mobility considerably breaking ventilation and haemo dynamics in lungs. Their number includes the diseases deforming a thorax (kifoskolioza, Bekhterev's disease, etc.), neuromuscular diseases (poliomyelitis), pathologies of a pleura, a diaphragm (after a torakoplastika, at a pneumosclerosis, diaphragm paresis, Pikvik's syndrome at obesity, etc.).
The vascular shape of pulmonary heart develops at primary defeats of pulmonary vessels: primary pulmonary hypertensia, pulmonary vaskulita, thrombembolia of branches of a pulmonary artery (TELA), sdavleniye of a pulmonary trunk aorta aneurism, atherosclerosis of a pulmonary artery, sredosteniye tumors.
Massive TELA, heavy attacks of bronchial asthma, valvate pheumothorax, acute pneumonia are the main reasons for sharp pulmonary heart. Pulmonary heart of a subsharp current develops at repeated TELA, a cancer lymphangitis of lungs, in the cases of chronic hypoventilation connected with poliomyelitis, botulism, a myasthenia.
Mechanism of development of pulmonary heart
In development of pulmonary heart arterial pulmonary hypertension has the leading value. At an initial stage it is also connected with reflex increase in warm emission in response to strengthening of respiratory function and the hypoxia of fabrics arising at respiratory insufficiency. At a vascular shape of pulmonary heart resistance to a blood-groove in arteries of a small circle of blood circulation increases generally due to organic narrowing of a gleam of pulmonary vessels at obstruction of their embolama (in case of a thrombembolia), at inflammatory or tumoral infiltration of walls, a zarashcheniya of their gleam (in case of system vaskulit). At bronchopulmonary and torakodiafragmalny shapes of pulmonary heart narrowing of a gleam of pulmonary vessels happens at the expense of their microthrombosis, a zarashcheniye connecting fabric or a sdavleniye in zones of an inflammation, tumoral process or a sklerozirovaniye, and also when easing ability of lungs to stretching and fall of vessels in the changed segments of lungs. But in most cases the leading role is played by functional mechanisms of development of pulmonary arterial hypertension which are connected with violations of respiratory function, ventilation of lungs and a hypoxia.
Arterial hypertension of a small circle of blood circulation leads to an overload of the right departments of heart. In process of development of a disease there is a shift of acid-base balance which originally can be compensated, but further there can be a decompensation of violations. At pulmonary heart increase in the sizes of the right ventricle and a hypertrophy of a muscular cover of large vessels of a small circle of blood circulation, narrowing of their gleam with a further sklerozirovaniye is observed. Small vessels quite often are surprised multiple blood clots. Gradually in a cardiac muscle dystrophy and necrotic processes develops.
Classification of pulmonary heart
On the speed of increase of clinical manifestations distinguish several options of a current of pulmonary heart: sharp (develops in several hours or days), subsharp (develops for weeks and months) and chronic (arises gradually, during a row of months or years against the background of long respiratory insufficiency).
Process of formation of chronic pulmonary heart takes place the following stages:
- preclinical – it is shown by tranzitorny pulmonarny hypertensia and signs of hard work of the right ventricle; come to light only at a tool research;
- compensated – it is characterized by a hypertrophy of the right ventricle and stable pulmonarny hypertensia without the phenomena of insufficiency of blood circulation;
- dekompensirovanny (warm and pulmonary insufficiency) - symptoms of insufficiency of the right ventricle appear.
Allocate three etiologichesky shapes of pulmonary heart: bronchopulmonary, torakodiafragmalny and vascular.
On the basis of compensation chronic pulmonary heart can be compensated or dekompensirovanny.
Symptoms of pulmonary heart
The clinical picture of pulmonary heart is characterized by development of the phenomena of heart failure against the background of pulmonary hypertensia. Development of sharp pulmonary heart is characterized by emergence of sudden pain behind a breast, sharp short wind; a lowering of arterial pressure, up to development of a collapse, cyanosis of integuments, swelling of cervical veins, the accruing tachycardia; the progressing increase in a liver with pains in the right podreberye, psychomotor excitement. The strengthened pathological pulsations (prekardialny and epigastralny), expansion of border of heart to the right, a gallop rhythm in a zone of a xiphoidal shoot, the ECG - signs of an overload of the right auricle are characteristic.
At massive TELA in several minutes a state of shock, hypostasis of lungs develops. Quite often the sharp coronary insufficiency which is followed by violation of a rhythm, a pain syndrome joins. In 30-35% of cases sudden death is observed. Subsharp pulmonary heart is shown by sudden moderate pain, short wind and tachycardia, short faint, a blood spitting, symptoms of a pleuropneumonia.
In a phase of compensation of chronic pulmonary heart the symptomatology of the main disease with gradual manifestations of hyperfunction, and then and hypertrophy of the right departments of heart which are usually softly expressed is observed. At some patients the pulsation in the top part of a stomach caused by increase in the right ventricle is noted.
Right ventricular insufficiency develops in stages of a decompensation. As the main manifestation serves the short wind amplifying at physical activity, inhalation of cold air in lying situation. There are pains in heart, cyanosis (warm and cold cyanosis), tachycardia, the swelling of cervical veins remaining on a breath, the increase in a liver, peripheral hypostases steady against treatment.
At inspection of heart dullness of warm tones comes to light. Arterial pressure is normal or is lowered, the arterial hypertension is characteristic of stagnant heart failure. Become more expressed symptoms of pulmonary heart at an aggravation of inflammatory process in lungs. In a late stage hypostases amplify, increase in a liver progresses (gepatomegaliya), neurologic violations (dizziness, headaches, apathy, drowsiness) appear the diuresis decreases.
Diagnostics of pulmonary heart
Diagnostic criteria of pulmonary heart consider existence of diseases - causal factors of pulmonary heart, pulmonary hypertensia, increase and expansion of the right ventricle, right ventricular heart failure. Consultation of the pulmonologist and cardiologist is necessary for such patients. At survey of the patient pay attention to breath violation signs, cyanosis of skin, pain in heart etc. Direct and indirect signs of a hypertrophy of the right ventricle are defined on the ECG.
According to a X-ray analysis of lungs unilateral increase in a shadow of a root of a lung, its increased transparency, high standing of a dome of a diaphragm from defeat is observed, a vybukhaniye of a trunk of a pulmonary artery, increase in the right departments of heart. By means of spirometry the type and degree of respiratory insufficiency is established.
The hypertrophy of the right departments of heart, pulmonary hypertensia is defined on an echocardiography. For diagnostics of TELA the pulmonary angiography is carried out. When carrying out a radio isotope method of a research of the blood circulatory system change of warm emission, blood-groove speed, volume of the circulating blood, venous pressure is investigated.
Treatment of pulmonary heart
The main medical actions at pulmonary heart are directed to active therapy of the main disease (pheumothorax, TELA, bronchial asthma etc.). Symptomatic influence includes use of bronchial spasmolytics, mukolitichesky means, respiratory analeptik, oxygenotherapies. The Dekompensirovanny current of pulmonary heart against the background of bronchial obstruction demands constant reception of glucocorticoids (Prednisolonum, etc.).
For the purpose of correction of arterial hypertension at patients with chronic pulmonary heart application of an eufillin (intravenously, inside, rektalno), at early stages - nifedipine is possible, at a dekompensirovanny current - nitrates (isosorbide of dinitrate, nitroglycerine) under control of gas composition of blood because of danger of strengthening of a gipoksemiya.
At the phenomena of heart failure purpose of warm glycosides and diuretics with respect for precaution in view of high toxicity of action of glycosides on a myocardium, especially in the conditions of a hypoxia and a gipokaliyemiya is shown. Correction of a gipokaliyemiya is carried out by potassium medicines (asparaginate or chloride of potassium). From diuretics preference is given to kaliysberegayushchy medicines (to a triamteren, a spironolakton, etc.).
In cases of the expressed eritrotsitoz carry out bloodlettings on 200-250 ml of blood with the subsequent intravenous administration of infusion solutions of low viscosity (a reopoliglyukin, etc.). With pulmonary heart it is expedient to include use of prostaglandins of the powerful endogenous vazodilatator which are in addition possessing cytoprotective, anti-proliferative, anti-aggregation actions in therapy of patients.
The important place in therapy of pulmonary heart is allocated to antagonists of receptors of an endotelin (bozentana). Endotelin is a powerful vazokonstriktor of an endotelialny origin which level increases at various shapes of pulmonary heart. At development of acidosis carry out intravenous infusion of solution of a hydrocarbonate of sodium.
At the phenomena of insufficiency of blood circulation on right ventricular type kaliysberegayushchy diuretics (, are appointed, etc.), at left ventricular insufficiency warm glycosides are applied ( intravenously). For the purpose of improvement of metabolism of a cardiac muscle at pulmonary heart appointment a meldoniya inside, and also an orotat or asparaginate of potassium is recommended. In complex therapy of pulmonary heart the respiratory gymnastics, LFK, massage, hyperbaric oxygenation is used.
Forecast and prevention of pulmonary heart
In cases of development of a decompensation of pulmonary heart the forecast for working capacity, quality and life expectancy unsatisfactory. Usually working capacity at patients with pulmonary heart suffers already at early stages of a disease that dictates need of rational employment and the solution of a question of assignment of group of disability. The early beginning of complex therapy allows to improve considerably the labor forecast and to increase life expectancy.
Prevention of pulmonary heart requires the prevention, timely and effective treatment of the diseases bringing to it. First of all, it concerns chronic bronchopulmonary processes, need of the prevention of their aggravations and development of respiratory insufficiency. For prevention of processes of a decompensation of pulmonary heart it is recommended to adhere to moderate physical activity.