Pulmonary heart

Description:

Pulmonary heart (Latin cor pulmonale) — the increase and expansion of the right departments of heart as a result of increase in arterial pressure in a small circle of blood circulation which developed owing to diseases of bronchial tubes and lungs, defeats of pulmonary vessels or deformations of a thorax.

Acute pulmonary heart — the clinical symptom complex arising, first of all, owing to development of a thromboembolism of a pulmonary artery (TELA) and also at a number of diseases of cardiovascular and respiratory systems. The tendency to growth of frequency of development of an acute pulmonary heart connected with increase in cases of TELA is in recent years noted.

The greatest number of TELA is noted at patients with cardiovascular diseases (coronary heart disease, a hypertension, rheumatic heart diseases, phlebothromboses).

The chronic pulmonary heart develops for a number of years and proceeds at the beginning without heart failure, and then with development of a decompensation. In recent years the chronic pulmonary heart meets more often that is connected with growth of incidence of the population of acute and chronic pneumonias, bronchitis.

Symptoms of the Pulmonary heart:

The acute pulmonary heart develops within several hours, days and, as a rule, is followed by the phenomena of heart failure. At slower rates of development the subacute option of this syndrome is observed. The acute course of a thrombembolia of a pulmonary artery is characterized by sudden development of a disease against the background of full wellbeing. There are sharp short wind, cyanosis, thorax pains, excitement. The thromboembolism of the main trunk of a pulmonary artery quickly, during of several minutes before half an hour, leads to development of a depressed case, fluid lungs.

When listening a large number of wet and scattered dry rattles is listened. The pulsation in the second — the third mezhreberye can come to light at the left. Swelling of cervical veins, the progressing increase in a liver, its morbidity at palpation are characteristic. Quite often there is an acute coronary insufficiency which is followed by a pain syndrome, disturbance of a rhythm and electrocardiographic symptoms of ischemia of a myocardium. Development of this syndrome is connected with emergence of shock, a prelum of veins, an expanded right ventricle, irritation of nervous receptors of a pulmonary artery.

The further clinical picture of a disease is caused by formation of a myocardial infarction, is characterized by emergence or strengthening of the pains in a thorax connected with the act of breath, an asthma, cyanosis. Expressiveness of two last manifestations is less in comparison with an acute phase of a disease. There is cough, usually dry or with department of a scanty phlegm. In half of cases the pneumorrhagia is observed. At most of patients the body temperature usually steady against action of antibiotics increases. At a research permanent increase of a cordial rhythm, weakening of breath and wet rattles over an affected area of a lung comes to light.
Subacute pulmonary heart. The subacute pulmonary heart is clinically shown by sudden moderate pain at breath, quickly passing asthma and a cardiopalmus, a faint, is frequent a pneumorrhagia, pleurisy symptoms.
Chronic pulmonary heart. It is necessary to distinguish the compensated and dekompensirovanny chronic pulmonary heart.
In compensation phase the clinical picture is characterized mainly by symptomatology of a basic disease and gradual accession of signs of increase in the right departments of heart. At a number of patients the pulsation in an upper part of a stomach comes to light. The main complaint of patients is an asthma which is caused by both respiratory insufficiency, and accession of heart failure. An asthma amplifies at a physical tension, inhalation of cold air, in a prone position. Exchange disturbances of a myocardium, and also relative insufficiency of coronary circulation in the increased right ventricle are the reasons of pains in heart at a pulmonary heart. Pain in heart can be explained also with existence of a pulmonary and coronary reflex owing to pulmonary hypertensia and stretching of a trunk of a pulmonary artery. At a research cyanosis often comes to light.

Important sign of a pulmonary heart is swelling of cervical veins. Unlike respiratory insufficiency when cervical veins bulk up in the period of a breath, at a pulmonary heart cervical veins remain bulked up both on a breath, and on an exhalation. The pulsation in an upper part of a stomach caused by increase in a right ventricle is characteristic.

Arrhythmias at a pulmonary heart happen seldom and usually arise in combination with an atherosclerotic cardiosclerosis. Arterial pressure usually normal or lowered. An asthma at a part of patients with the expressed decrease in level of oxygen in blood, especially at development of congestive heart failure owing to compensatory mechanisms. Development of an arterial hypertension is observed.

At a number of patients development of stomach ulcers is noted that it is connected with disturbance of gas composition of blood and decrease in stability of a mucous membrane of system of a stomach and a 12-perstny gut.

The main symptoms of a pulmonary heart become more expressed against the background of an aggravation of inflammatory process in lungs. Patients with a pulmonary heart have a bent to fall of temperature and even at an exacerbation of pneumonia temperature seldom exceeds 37 °C.

In an end-stage hypostases accrue, increase in a liver, decrease in amount of the emitted urine is noted, there are disturbances from a nervous system (headaches, dizziness, noise in the head, drowsiness, apathy) that is connected with disturbance of gas composition of blood and accumulation of nedookislenny products.

Reasons of the Pulmonary heart:

Are the main reasons for this state:

  1. a massive thromboembolism in system of a pulmonary artery;
  2. valve pheumothorax;
  3. heavy long attack of bronchial asthma;
  4. widespread acute pneumonia.

At repeated thromboembolisms of small branches of a pulmonary artery (blood clots, emboluses, eggs of parasites, etc.), a cancer limfangiit, botulism, a myasthenia the acute pulmonary heart with a subacute current can develop. It is necessary to refer increase in arterial pressure in a small circle of blood circulation to number of the factors promoting development of a thromboembolism of a pulmonary artery, developments of stagnation in a small circle of blood circulation, increase in coagulability and oppression of anticoagulative system of blood, disturbance in system of microcirculation of a small circle of blood circulation, atherosclerosis and vasculites in system of a pulmonary artery, low-mobility at a long bed rest, operative measures on veins of a basin and the lower extremities.

Treatment of the Pulmonary heart:

At development of a depressed case and approach of clinical death it is necessary to hold resuscitation events in full (a cardiac massage, an intubation, IVL). If resuscitation actions took place successfully, urgent operation with the purpose of removal of blood clot from a trunk of a pulmonary artery or administration of thrombolytic drugs in a pulmonary artery via the probe is necessary.