Pulmonary heart: symptoms and treatment
Pulmonary heart implies a kind of pathology of the right divisions in the heart, under which the ventricle enlarges and widens in combination with the right atrium. Pulmonary heart, the symptoms of which are also manifested against the background of circulatory insufficiency due to actual hypertension in a small circle of blood circulation (i.e., increased blood pressure), is formed as a result of pathological processes occurring in patients in the chest, bronchopulmonary system and in the lung vessels.
Like a number of other diseases, the pulmonary heart can manifest itself in acute or chronic forms (in addition, the subacute flow pattern is also relevant). The development of the acute form of the disease occurs quickly, within a period of several minutes to several hours / days.
As for the chronic form, here the duration of its development is of the order of several months / years. Approximately in 3% of cases the presence of bronchopulmonary pathologies in patients in chronic form determines for them the gradual development of the pulmonary heart. It should be noted that the pulmonary heart acts as an aggravating factor for the course of pathologies of cardiological scale — in this case, it is considered as the fourth cause of mortality in the case of cardiovascular diseases.
Pulmonary heart: causes
As already noted, the pulmonary heart can manifest in an acute, subacute or chronic form.
Acute pulmonary heart is characterized by a rapid increase in symptoms within a short period of time. The basis for the development of this form of the disease can be the following factors:
- Vascular damage . It occurs against the background of thromboembolism of the pulmonary artery in combination with its branches (abdominal PE is a pathology at which there is clotting of thrombi) or against the background of pneumomediastinum (otherwise — spontaneous emphysema of the mediastinum, which is a fairly rare independent disease in which infiltration of the mediastinal cord with air, What happens for no specific reason and determines the subsequent benign course.)
- Bronchopulmonary pathology. In this case, extensive forms of pneumonia, as well as severe forms of bronchial asthma, may develop in patients with asthmatic status.
As for the next form, and this is subacute pulmonary heart, then for its development a time span of several weeks to several months is needed. As the reasons against which this form of pathology can develop, you can determine the following options:
- Vascular damage. In this case, the options for recurrence of microemboli in the small size of the branches of the pulmonary artery, as well as the primary form of pulmonary hypertension and pulmonary vasculitis are considered.
- Diseases of the bronchopulmonary system. In this case, such pathologies that serve as the causes of subacute pulmonary heart disease, such as diffuse form of fibrotic alveolitis, severe forms of bronchial asthma, and current oncological processes, In the mediastinum region (in other words — lymphogenous lung carcinomatosis, developing against the backdrop of distant metastases in malignant tumoral formations of the urinary system, prostate, stomach, etc.).
- Thoracodiaphragmatic pathology. In this case, alveolar hyperventilation is considered, which is relevant for such pathologies as myasthenia gravis, poliomyelitis and botulism
The chronic pulmonary heart, which is also noted, develops over a period of several years. As the main reasons provoking the development of this form of pathology, we can distinguish the following options:
- Vascular damage. In this case, it is considered against the background of the urgency for the patient of the primary form of pulmonary hypertension, recurrent embolism, arteritis, or the transfer of surgery to remove a part of the lung or lung completely.
- Diseases of the bronchopulmonary system. In this case, obstructive diseases affecting bronchi (pneumosclerosis, bronchial asthma, pulmonary emphysema, chronic bronchitis, etc.), various forms of fibrosis and granulomatosis, processes of restrictive scale, numerous cystic lesions that affect the lungs may be relevant.
- Thoraco-diaphragmatic pathologies. In this case, options are considered such as obesity provoked by a disease, adhesions affecting the pleura, as well as lesions of the spine and chest, in which their deformation occurs.
Pulmonary heart: mechanism of development
Pulmonary hypertension plays a leading role in the formation of a pulmonary heart in patients. In the initial stage, it is closely related to increased cardiac output at the reflex level, this reaction is a response to the increased respiratory function and tissue hypoxia developing against the background of respiratory failure.
The vascular form of the pulmonary heart is accompanied by resistance to blood flow in the arteries corresponding to a small circle of blood circulation, which occurs primarily due to the organic form of constriction of the lumen in the pulmonary vessels against embolism, when considering the connection with thromboembolism, as well as against a tumor or inflammatory Forms of infiltration of the walls when the lumen is inflamed (when considering the connection with systemic vasculitis).
Bronchopulmonary and thoracodiaphragmatic manifestations of the pulmonary heart are accompanied by narrowing of the lumen within the pulmonary vessels, which is due to the actual microthrombosis for them and infection by means of connective tissue, or because of actual compression occurring in the area of a tumor, inflammatory or sclerosing process. In addition, the narrowing of the lumen of the pulmonary vessels can arise against the background of the weakening of the lungs as regards the ability of their vessels to stretch and collapse due to changes that have arisen in the pulmonary segments. Meanwhile, in the vast majority of cases, the main role is assigned to functional mechanisms against which already developed pulmonary arterial hypertension develops, these mechanisms are directly related to disturbances arising in the respiratory function, with ventilation and with the development of hypoxia.
This factor, hypertension proper, becomes the cause of congestion of the heart, and in particular of its right divisions. The gradual development of the disease leads to changes in the acid-base balance (initially it can be defined as compensated, but subsequently reach a state of decompensation of the disorders). In frequent cases, the small vessels are affected by numerous thrombi, the heart muscle gradually reaches the state of dystrophy in combination with necrotic processes.
The chronic process of pulmonary heart disease determines the following classification of stages:
- the preclinical stage — is characterized by the manifestation of the pulmonary form of hypertension in combination with the signs indicating the intensity of the functioning of the right ventricle; The identification of this stage is possible only when conducting an instrumental study;
- the compensated stage — for its course is characterized by right ventricular hypertrophy in combination with pulmonary hypertension in a stable form of manifestation without reaching the state of circulatory insufficiency;
- decompensated stage (cardiopulmonary insufficiency) — the symptoms appear in the actual form for the right ventricular failure.
Pulmonary heart: symptoms
Acute pulmonary heart is accompanied by the appearance of complaints about the sharp soreness that appears in the chest area, which occurs in combination with a pronounced form of dyspnoea. Also, patients develop cyanosis (cyanosis of the skin and mucous membranes), swelling of veins on the neck occurs. The arterial pressure is reduced, the pulse is rapid (from 100 beats or more). The possibility of pain in the right hypochondrium due to liver damage, the appearance of nausea and vomiting is not ruled out.
The subacute pulmonary heart is accompanied by a similar acute course, but the manifestations of the symptomatology are noted in another time interval, that is, not immediately, but in a time-stretched version. P >
Chronic pulmonary heart and the symptoms accompanying it appear until the moment of decompensation, over a long period of time they can be caused by the urgency of bronchopulmonary pathology considered as the underlying disease. Early signs of the pulmonary heart in this form consist in the increase in heart rate, as well as in increased fatigue against the background of the standard type of load. Gradually, there is an increase in dyspnea in patients. Within the course of the first degree of this disease, dyspnea occurs only in serious forms of physical activity, while the achievement of grade III determines the relevance of this symptom even at rest.
Again, in patients with frequent cases, there is an increase in heart rate. The painful sensations arising in the region of the heart can have an intense character of manifestation, disposal of them is possible with special oxygen inhalation. There is no clear correlation between the appearance of pain and the loads exercised by the patient. With the use of nitroglycerin, the pain does not pass in this case.
The common form of cyanosis is also supplemented by the addition of such a symptom as the appearance of purple-bluish coloration of the skin in the region of the ears, lips and nasolabial triangle. Cervical veins may swell, edema may occur (damage to the lower extremities), severe forms of the disease in chronic form are accompanied by development in patients with ascites, in which fluid accumulates in the abdominal cavity.
An important feature of the chronic form of this disease is that it is the result of a severe and prolonged course of bronchopulmonary pathologies, resulting in a gradual decrease in the overall performance of patients, a decrease in the quality of their lives, further disability and, ultimately, death .
As diagnostic criteria of the pulmonary heart, topical diseases are distinguished that act as causative factors in the development of the pulmonary heart and conditions, also leading to it (right ventricular enlargement and enlargement, pulmonary hypertension, right ventricular heart failure). Also, manifestations of symptoms characteristic of the disease (breathing disorder, dyspnea, pain in the heart, cyanosis, etc.) are taken into account.
When conducting an ECG, you can identify indirect and direct signs that determine hypertrophy of the right ventricle. Also used is the method of radiography, in which it is possible to determine changes in the lung (the shadow of its root increases, increased transparency and other specific changes are noted). Spirodermia makes it possible to establish the degree and type of respiratory failure. Echocardiography reveals the relevance of hypertrophy from the right heart. Diagnosis of PE is based on the use of pulmonary angiography. The radioisotope method makes it possible to investigate the circulatory system relative to the characteristics of cardiac output, the volume of blood circulation, the speed of blood flow, and the venous pressure.
Pulmonary heart: treatment
An acute pulmonary heart is treated by applying resuscitation measures, as well as measures by which to restore the patency of the vessels of the lungs. They also focus on the implementation of measures to eliminate the pain syndrome. Thromboembolic therapy is performed during the first 4-6 hours from the time of onset of the manifestations that are relevant for the disease in the case of massive thromboembolism of the pulmonary artery. The unreasonableness of the measures of this therapy determines when it is used within the later terms. It is conducted in a hospital.
Modern advances in medicine, unfortunately, determine until the treatment of the pulmonary heart as a very difficult task. At his expense, meanwhile, it is possible to consider a slowdown in the progression of the course of the disease, a certain increase in the life expectancy of patients and an improvement in the level of its quality. Within the framework of a comprehensive approach to the treatment of the pathology in question, they are guided by the treatment of the disease, which is the main one in this case, as well as the elimination of disturbances in gas exchange and respiratory failure, the elimination of symptoms, concomitant cardiac failure during decompensation or its manifestations. P >
In almost all cases, oxygen inhalation is necessary. A significant role is given to the rejection of harmful habits (in particular, it concerns smoking), the elimination of the effects of industrial negative factors, as well as the detection and subsequent removal of allergens from the body with the prevention of further ingestion into the environment of the organism, etc. A certain role is assigned to respiratory gymnastics and massage of the thoracic region Cells. In the presence of an inflammatory chronic respiratory disease, training is needed on the part of the positional drainage of the bronchi.
Folk remedies in the treatment of the pulmonary heart, as well as self-medication, are considered at least as a method of ineffective therapy, within which the most important thing is lost — time.
If symptoms appear that indicate the possible relevance of such a diagnosis as a pulmonary heart, it is necessary to consult a pulmonologist, a cardiologist and a treating therapist.