- acute pulmonary heart;
- subacute stage;
- a chronic process.
In the first case, the pathology develops very quickly (a maximum of several days). In contrast, the chronic form can be asymptomatic for two to three months, and even years. Patients suffering from pulmonary diseases also have a risk of developing the syndrome, and this happens in about 3% of cases.
Pulmonary heart often acts as a complication of cardialgia. The disease is in fourth place in the frequency of deaths that occur among all diseases of the cardiovascular system.
Each of the forms of the disease is characterized by its provocative factors. In the acute form, the symptoms manifest quickly and worsen over a short time period. This happens for the following reasons:
- With thromboembolism of a lung artery, vascular damage occurs. Similar consequences can occur as a result of spontaneous emphysema of the mediastinum. Most often, this disease occurs against the background of other pathologies. If treatment is started on time, then the prognosis of recovery will be positive.
- Pulmonary and bronchial pathologies. If the patient suffers from extensive bronchial asthma or advanced pneumonia, then in the absence of adequate treatment, he may develop a pulmonary heart.
The acute is followed by a subacute form. Its development can continue for several weeks, and can drag on for a couple of months. The reasons in this case are:
- Microembolism, which caused extensive vascular lesions. Usually, small arterial branches suffer from this disease. Other factors causing the development of pathology: hypertension and pulmonary vasculitis.
- Diseases of the bronchopulmonary system. We are talking about fibrosing alveolitis in diffuse form, as well as bronchial asthma in advanced stages. Such violations can be triggered by oncology that has arisen in the area of the mediastinum (lymphogenous pulmonary carcinomatosis).
- Thoracodiaphragmatic pathologies, which include alveolar hyperventilation, which occurs against the background of botulism and poliomyelitis.
The next step is a chronic pulmonary heart. As mentioned above, the period of its development is several years. There are such causes of the process:
- Vascular lesions that occur during the initial stages of pulmonary hypertension, arteritis, relapse of embolism, as well as surgical procedures aimed at removing the lung or its part.
- Thoracodiaphragmatic pathologies, such as excess weight, pleural adhesive processes, problems with the chest and spine, causing their deformation.
- Bronchopulmonary ailments caused by obstructive diseases of the bronchi, such as asthma, pneumosclerosis, emphysema, chronic bronchitis. This can also include various forms of granulomatosis and fibrosis, acid neoplasms in the pulmonary structure.
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The mechanism of the development of the disease can suggest two ways: anatomical and functional. In the latter case, the course of the disease can be adjusted, therefore, the prognosis is more favorable.
In this case, there is a decrease in the network of vessels of the pulmonary artery. This process occurs due to damage to the alveolar walls, which ultimately turns into their complete death and the formation of blood clots in small vessels.
The appearance of the first symptoms of pathology occurs already with damage to 5% of small pulmonary vessels. At 15% reduction, the growth of the right ventricle is observed, when the vascular bed is reduced by a third, the process of decompensation of the pulmonary heart begins.
As a result of the above changes, the right ventricle begins to grow rapidly in size, which leads to circulatory failure. At the same time, the contractile function of the organ worsens already in the first stages of pulmonary hypertension, due to which the blood flow decreases. When the process is completed, the ventricle is already in a pathological condition.
- The minute volume of blood increases. The pressure in the arterioles of the lungs is constantly increasing in parallel with the amount of flu >
Modern cardiology involves three forms of this disease: acute, subacute and chronic. Regarding etiology, three more types are distinguished:
- Vascular, in which pathology occurs against a background of disorders in the vessels of the lungs. A similar course is characterized by thrombosis, vasculitis, pulmonary hypertension and other disorders observed in the vessels.
- Bronchopulmonary, which affects patients with bronchopulmonary ailments. At risk are patients with tuberculosis, bronchial asthma, chronic bronchitis.
- Thoracodiaphragmatic, the development of which is observed against the background of worsening pulmonary ventilation. A similar condition can occur as a result of a number of diseases, such as pleural fibrosis, kyphoscoliosis. Their consequence is impaired mobility of the chest, which interferes with the normal breathing process.
The main symptoms of a pulmonary heart:
- the appearance of sharp pain in the sternum;
- drop in blood pressure;
- noticeable shortness of breath;
- increased heart rate;
- expansion of the cervical veins;
- pain localized in the liver, nausea and vomiting.
This is how the pulmonary heart manifests in acute form. The subacute stage has similar symptoms, but it does not develop so sharply and rapidly.
The chronic form of the disease has the following symptoms:
- accelerated pulse;
- shortness of breath, increasing over time (at first it occurs only under exertion, and then at rest);
- severe pain in the region of the heart that cannot be stopped with Nitroglycerin (the main difference between this disease and angina pectoris);
- swelling of the legs, ascites (fluid accumulation in the abdomen), an increase in cervical veins;
- cyanosis (blueness of the ears, nasolabial triangle and lips).
If two or three of the above symptoms occur, you should immediately consult a doctor. Diagnosis and treatment of pulmonary heart disease usually involves a range of measures. The diagnosis is as follows:
Features of treatment
Pulmonary acute heart – description, causes, symptoms (signs), diagnosis, treatment.
Acute pulmonary heart (OLS) is a clinical syndrome of acute right ventricular failure caused by sudden pulmonary hypertension in pulmonary vascular obstruction. A classic example is TELA. Acute pulmonary heart develops within minutes, hours or days.
Etiology • TELA • Fatty, gas, tumor embolism • Pulmonary vein thrombosis • Valvular pneumothorax, pneumomediastinum • Pulmonary infarction • Lobar or total pneumonia • Severe attack of bronchial asthma, asthmatic status • Pulmonary cancer, central and peripheral hypoglycemia, and b myasthenia gravis) • Pulmonary arteritis • Lung resection • Massive pulmonary atelectasis • Multiple rib fractures, sternal fracture (floating chest) • Rapid accumulation of fluid awns in the pleural cavity (hemothorax, exudative pleurisy, massive fluid infusion through the subclavian catheter, erroneously inserted into the pleural cavity).
Risk factors • Deep vein thrombophlebitis of the lower extremities • Postoperative or postpartum period • Bronchopulmonary pathology.
Pathogenesis • Acute development of pulmonary hypertension (with massive pulmonary embolism, the right ventricle loses completely or decreases its ability to pump blood into the pulmonary circulation, resulting in acute right ventricular failure) • Severe bronchoconstriction • Development of pulmonary heart, pulmonary vascular and pulmonary – coronary reflexes – a sharp decrease in blood pressure, worsening of coronary blood flow • Acute respiratory failure • See also Pulmonary secondary hypertension.
Clinical manifestations – a sudden deterioration in the patient’s condition within a few minutes or hours (less often days) against the background of complete well-being or a stable course of the underlying disease. Sometimes it develops lightning fast.
• Dyspnea, shortness of breath, fear of death, severe cyanosis, acrocyanosis.
• Pain: chest pain, with pulmonary embolism – side pain associated with breathing (often in combination with hemoptysis). Sharp pains in the right hypochondrium due to enlargement of the liver with the rapid development of right ventricular failure may appear.
• Cervical vein swelling also due to the development of acute right ventricular insufficiency.
• Decrease in blood pressure up to the collapse state and tachycardia of 100–160 per minute due to a decrease in cardiac output.
• Auscultation of the lungs – signs of the pathological process that caused the OLS: weakening, lack of respiratory sounds or bronchial breathing, dry and/or wet rales, pleural friction noise.
• Auscultation of the heart – emphasis II tone over the pulmonary artery, increased cardiac impulse, often arrhythmia (extrasystole atrial and ventricular, atrial fibrillation), sometimes systolic murmur of tricuspid valve insufficiency, gallop rhythm.
• Sometimes there is a mismatch between the severity of the patient’s condition and the normal results of percussion and auscultation of the lungs.
Laboratory data • Hypoxia (decrease in pA2) • Hyperventilation (as measured by a drop in pA2) • Moderate acute respiratory alkalosis (low pA2 and elevated pH values).
• X-ray examination of the chest organs •• Signs of pneumothorax, fluid in the pleural cavity, total pneumonia, atelectasis •• Even with massive embolisms, radiological changes in the lungs may be absent •• Pulmonary angiography – determination of the location of the thrombus if emergency embolectomy is necessary.
Differential diagnosis – acute right ventricular failure with MI of the right ventricle.
Etiological treatment; symptomatic is aimed at correcting hypoxia and acidosis, controlling hypervolemia and correcting right ventricular failure.
• Oxygen therapy. The initial stages of treatment for OLS should include the use of oxygen and the improvement of the ventilation capacity of the patient’s lungs with correction of the underlying pulmonary disease. Since many patients are sensitive to oxygen, it is necessary to avoid its use in high concentrations, and to maintain saturation at the level of 90%.
• Diuresis. Fluid retention is typical and can interfere with pulmonary gas exchange and increase pulmonary vascular resistance. Improving oxygenation and limiting salt is quite sufficient, but it is often necessary to prescribe diuretics.
• Bloodletting provides a short-term effect and may be useful at Ht levels above 55-60%.
• Cardiac glycosides do not give a good effect in the absence of left ventricular failure.
• Vasodilators are widely used, especially in cases mediated by obliterating vascular lesions or pulmonary fibrosis. However, the effectiveness of the drugs is called into question.
Reduction • OLS – acute pulmonary heart.
ICD-10 • I26.0 Pulmonary embolism with reference to acute pulmonary heart
An increase in blood pressure in the pulmonary circulation associated with pathological processes in the lungs causes a thickening of the myocardium and an increase in the volume of the right atrium and right ventricle. Such a change in the heart muscle is called pulmonary heart syndrome or simply – “pulmonary heart”. The development of pulmonary heart syndrome can be acute, subacute, or chronic.
Acute pulmonary heart manifests itself in case of impaired vascular patency (for example, thromboembolism of the main trunk or branches of the pulmonary artery) or diseases of the bronchi and lungs (obstructive bronchitis. Pneumonia). Pathological disorders are detected within a few hours.
An subacute pulmonary heart is characterized by an increase in the pathological state of the myocardium over a certain period of time (weeks or months). The reasons for its occurrence are microembolism of the pulmonary arterioles, pulmonary vasculitis, pulmonary hypertension, fibrotic changes in the walls of the pulmonary arteries, metastasis of the mediastinum as a result of neoplasms of the esophagus, stomach and other organs, complicated bronchial asthma.
Pathological processes in chronic pulmonary heart increase in the period from one year to several years. The causes of the development of chronic pulmonary heart are vascular disorders (arteritis, embolism), diseases of the bronchi and lungs (obstructive bronchitis, bronchial asthma. Pulmonary emphysema, partial or complete removal of one lung, fibrocystic formations in the lung tissue), infectious diseases (tuberculosis), pathological deformations and injuries of the chest, diseases of a neuromuscular nature (apnea, poliomyelitis), adhesions in the pleural cavity, obesity.
Characteristic symptoms of a pulmonary heart:
- an attack of sharp pain in the chest;
- increasing shortness of breath;
- cyanosis (blue lips, nails, skin of the face);
- possible swelling of the cervical veins;
- increased heart rate (above 100 beats per minute);
- tachycardia (heart palpitations);
- pain in the heart;
- swelling of the lower extremities.
When examining a patient, the following are revealed:
- an increase in the volumetric dimensions of the heart (especially on the right),
- expansion of the border of the heart to the right of the sternum,
- heart murmurs
- enlarged liver.
When diagnosing a disease, a history of bronchopulmonary diseases must be taken into account.
Pulmonary heart treatment depends on the severity and speed of the process. In the acute form of the pulmonary heart, resuscitation measures are carried out to combat pain, restore vascular patency; carry out inhalation with oxygen or artificial ventilation of the lungs.
In chronic pulmonary heart syndrome, in addition to measures to improve or restore blood supply to the heart and brain, drug therapy of diseases that cause the development of pulmonary heart syndrome is carried out:
- For infections of the respiratory system, antimicrobial therapy is performed,
- In obstructive processes in the bronchi, bronchodilators are prescribed,
- To reduce pulmonary hypertension, calcium antagonists take, which have a vasodilating effect due to relaxation of the smooth muscles of the walls of blood vessels and bronchi,
- With a tendency to thromboembolism of the vessels of the lungs, blood thinners are used (antiplatelet agents, fibrinolytics),
- To improve vascular patency, vasodilators are used,
- To improve and support the functioning of the heart muscle, cardiac glycosides are taken,
- To lower the pressure, diuretic herbal or synthetic drugs are taken, as well as drugs that normalize blood pressure,
- Perform regular oxygen inhalations,
- Assign respiratory gymnastics, chest massage to eliminate congestion in the bronchopulmonary structures.
If pulmonary heart syndrome is detected, it is necessary to conduct treatment in a timely and correct manner, since pulmonary heart can cause heart failure and death.
The site provides background information. Adequate diagnosis and treatment of the disease is possible under the supervision of a conscientious doctor.
In cardiology, a pulmonary heart is a complex of symptoms that occurs when blood pressure rises in the pulmonary circulation. This problem is usually found in various lung diseases, but can be caused by other reasons. The main problem is the expansion of the right heart (atrium and ventricle), which is a characteristic sign of this pathology.
The prevalence of this heart disease in the world is very difficult to assess. Most researchers agree that this problem is more or less present in 5 to 10% of all patients with diseases of the respiratory and cardiovascular systems. According to other sources, it is the third most common (after coronary heart disease and arterial hypertension) heart disease.
It is difficult to give an accurate assessment of the situation, because in many patients with a special examination you can find signs of expansion of the right ventricle, but clinical symptoms are not always observed. It is believed that the disease affects men more often and is generally atypical for young patients. Most people come with characteristic complaints and symptoms after 40 to 50 years, but there are also cases among young people.
Chronic pulmonary heart
The concept of “chronic pulmonary heart” combines a number of conditions in which pulmonary arterial hypertension and right ventricular failure form over several years. This condition significantly aggravates the course of many chronic bronchopulmonary and cardiological pathologies and can lead the patient to disability and death.
Chronic pulmonary heart is formed with a long-existing bronchiectatic disease, as well as some other diseases of the respiratory system.
Depending on the causes of the development of the pulmonary heart, three forms of this pathological condition are distinguished:
Cardiologists and pulmonologists distinguish three groups of pathological conditions and diseases that can lead to the development of chronic pulmonary heart:
- Group I: lesions of the bronchopulmonary apparatus (chronic bronchitis, pneumoconiosis, bronchiectasis, pulmonary fibrosis in pulmonary tuberculosis, high-altitude hypoxemia, sarcoidosis, bronchial asthma, dermatomyositis, systemic lupus erythematosus, cystic fibrosis, alveolar microlithiasis, berylliosis, etc.
- Group II: diseases accompanied by pathological violation of chest mobility (kyphoscoliosis, exhaustion, thoracoplasty, Pickwick syndrome, obesity, pleural fibrosis, ankylosing spondylitis, neuromuscular diseases, etc.);
- Group III: diseases leading to secondary damage to the pulmonary vessels (embolism against extrapulmonary thrombosis, pulmonary hypertension, vasculitis, pulmonary vascular compression aneurysm, schistosomiasis, pulmonary thrombosis, mediastinal tumors, periarteritis nodosa).
During this pathological condition, three stages are distinguished. We list them:
- preclinical: can be detected only after an instrumental diagnostic study, manifests itself with signs of transient arterial hypertension and symptoms of overload of the right ventricle;
- compensated: accompanied by right ventricular hypertrophy and constant pulmonary hypertension, the patient is usually disturbed by the symptoms of the underlying disease, signs of heart failure are not observed;
- decompensated: the patient has signs of right ventricular failure.
According to WHO statistics, most often chronic pulmonary heart is provoked by such diseases:
- chronic infectious diseases of the bronchial tree;
- bronchial asthma (stage II-III);
- emphysema of the lungs;
- damage to the lung tissue by parasites;
- thromboembolic disease;
- chest deformities.
In 80% of cases, pulmonary hypertension caused by diseases of the respiratory system leads to the formation of a pulmonary heart.
With the thoracodiaphragmatic and bronchopulmonary form of this pathology, vascular lumen is contaminated with connective tissue and microthrombi, compression of the pulmonary arteries and veins in areas of tumor or inflammatory processes.
Vascular forms of the pulmonary heart are accompanied by impaired blood flow, provoked by clogging of the pulmonary vessels with emboli and inflammatory or tumor infiltration of the vascular walls.
Such structural changes in the arteries and veins of the pulmonary circulation lead to a significant overload of the right heart and are accompanied by an increase in the size of the muscular membrane of blood vessels and the myocardium of the right ventricle. At the stage of decompensation, the patient begins to appear dystrophic and necrotic processes in the myocardium.
One of the first symptoms of HLC is shortness of breath during physical exertion, as well as in a prone position.
In the compensation stage, the chronic pulmonary heart is accompanied by severe symptoms of the underlying disease and the first signs of hyperfunction and hypertrophy of the right heart.
In the stage of decompensation of the pulmonary heart in patients, such complaints appear:
- shortness of breath, aggravated by physical exertion, inhalation of cold air and attempts to lie down;
- pains in the region of the heart that occur against the background of physical activity and are not stopped by taking Nitroglycerin;
- a sharp decrease in tolerance to physical activity;
- heaviness in the legs;
- swelling on the legs, worse in the evening;
- swelling of the cervical veins.
With the progression of chronic pulmonary heart, the patient develops a decompensation stage, and abdominal disorders appear:
- severe pain in the stomach and in the right hypochondrium;
- ascites formation;
- decrease in the amount of urine.
When listening, percussion and palpation of the heart is determined:
- deafness of tones;
- right ventricular hypertrophy;
- dilatation of the right ventricle;
- severe pulsation to the left of the sternum and in the epigastric region;
- accent II tone in the pulmonary artery;
- diastolic murmur after the II tone;
- pathological III tone;
- right ventricular IV tone.
In severe respiratory failure, the patient may experience various cerebral disorders, which can be manifested by increased nervous excitability (psycho-emotional arousal up to aggressiveness or psychosis) or depression, sleep disturbances, lethargy, dizziness, and intense headaches. In some cases, these violations may result in episodes of seizures and fainting.
Severe forms of decompensated pulmonary heart can proceed according to the collaptoid variant:
- a sharp decrease in blood pressure;
- cold sweat.
Patients with suspected chronic pulmonary heart should consult a pulmonologist and cardiologist and undergo the following types of laboratory and instrumental diagnostics:
- clinical blood test;
- ECHO cardiography;
- pulmonary angiography;
- catheterization of the right heart;
- tests for diffuse lung capacity;
- pneumotachigraphy, etc.
The main goals in the treatment of patients with chronic pulmonary heart disease are aimed at eliminating right ventricular failure and pulmonary hypertension. It also has an active effect on the underlying disease of the bronchopulmonary system, which entailed the development of this pathology.
For the correction of pulmonary arterial hypoxemia are used:
- bronchodilators (Berotek, Ventolin, Serevent, Theopec);
- oxygen inhalation;
These treatments help reduce hypercapnia, acidosis, arterial hypoxemia and lower blood pressure.
- potassium antagonists (Diltiazem, Nifedipine, Lacipil, Lomir);
- ACE inhibitors (captopril, quinapril, enalapril, raimpril);
- nitrates (Isosorbide dinitrate, Isosorbide-5-mononitrate, Monolong, Olikard);
- alpha1-blockers (Revocarin, Dalfaz, Fokusin, Saxon, Kornam).
The use of these drugs against the background of correction of pulmonary arterial hypoxemia is carried out under constant monitoring of the functional state of the lungs, blood pressure, pulse and pulmonary arteries.
Also, a complex of therapy for chronic pulmonary heart disease may include drugs for the correction of platelet aggregation and hemorrhagic disorders:
- low molecular weight heparins (Fraxiparin, Axapain);
- peripheral vasodilators (Vasonite, Trental, Pentoxifylline-Acre).
With decompensated chronic pulmonary heart and right ventricular failure, the patient may be recommended to take cardiac glycosides (Strofantin K, Digoxin, Korglikon), loop and potassium-sparing diuretics (Torasemide, Lasix, Pyretanide, Spironolactone, Aldactone, Amyloride).
Even in the last century, it became known that with emphysema, the heart can be involved in the pathological process (S.P. Botkin, R. Laennec). Various terms are used to indicate the corresponding pathological condition: emphysematous heart, pulmonary heart, pulmonary heart disease, cardiopulmonary syndrome or insufficiency, pulmonary hypertension.
The most common is the anatomical definition, formulated by the WHO Expert Committee in 1961, chronic pulmonary heart – right-handed ventricular hypertrophy, developing as a result of diseases that primarily violate the function and (or) lung structure, except when these disorders are the result of diseases, mainly affecting the left half of the heart, or congenital heart disease.
In subsequent years, this definition was modified and supplemented. One of the definitions says: under chronic pulmonary heart syndrome is understood hypertrophy or insufficiency of the right ventricle of the heart, accompanied by pulmonary hypertension and arising as a result of primary disease of the lungs, blood vessels of the lung or respiratory gas exchange disorders. Congenital and acquired heart defects and left ventricular failure do not enter the pulmonary heart.
With a number of diseases, acute or subacute overload of the right ventricle with its expansion occurs, while myocardial hypertrophy does not have time to develop. This syndrome is called an acute or subacute pulmonary heart.
Therefore, the concept of pulmonary heart includes hypertrophy, expansion, insufficiency of the right ventricle of the heart, pulmonary hypertension. However, all of these syndromes do not occur synchronously; they are separated in time by a period, the duration of which can be many years. So, from the occurrence of the first manifestations of pulmonary hypertension to the development of circulatory failure, but for the right ventricular type, tens of years can pass.