肺心病英文-內(nèi)科學(xué)課件

8肺心病英文中山大學(xué)內(nèi)科學(xué)8肺心病英文中山大學(xué)內(nèi)科學(xué)1肺心病英文-內(nèi)科學(xué)課件2肺心病英文-內(nèi)科學(xué)課件3MechanismandPathology（一）Pulmonaryhypertension：Definition：meanpulmonaryarterypressure（mPAP）≥25mmHgatrestor≥30mmHgduringexercise.FunctionalchangesinpulmonaryvascularHypoxia,Hypercapnia,Respiratoryacidosis,vasoconstrictionsubstances→Pulmonaryvasoconstriction→PulmonaryhypertensionHypoxiaisthemostimportantfactorleadstopulmonaryhypertensionAnatomicchangesinpulmonaryvascularRemodelingofpulmonaryvesselsIncreasedbloodviscosityandbloodvolumeMechanismandPathology（一）Pulm4MechanismandPathology（二）Dysfunctionofrightheart

Pulmonaryhypertension→Afterloadofrightventricular

↑,Oxygensupplyofmyocardium↓→Hypertrophyanddilatationoftherightventricle→Rightheartfailure

(三）Damagestoothervitalorgans：

MultipleorgandysfunctionMechanismandPathology（二）Dysf5ClinicalManifestationsCompensationstageofcardiacandlungfunctionSymptoms:cough,sputum,shortofbreath;dyspneaandpalpitationonexertion;fatigueanddecreaseofexercisetolerance;exacerbatedbyacuteinfection.Signs:cyanosis,signsofemphysema,moistralesand/orrhonchi;P2>A2,systolicmurmuroftricuspidarea,subxiphoidvisible/palpablecardiacimpulse,distendedjugularvenous.ClinicalManifestationsCompens6ClinicalManifestationsDecompensationstageofcardiacandlungfunction

Respiratoryfailure

Symtoms:severedyspnea,especiallyatnight,headache,insomnia,inappetence,somnolence,dizziness,confusion,evendelirium.Signs:conjunctivacongestionandedema,retinalvasodilatation,opticpapillaryedema;weaknessordisappearofdeepreflexes,pathologicalreflexes.

ClinicalManifestationsDecompe7ClinicalManifestationsDecompensationstageofcardiacandlungfunction

RightheartfailureSymtoms:dyspneaaggravated,palpitation,inappetence,abdominaldistention,nausea.Signs:cyanosis,arrhythmia,tachycardia,subxiphoidsystolicmurmurorevendiastolicmurmur.Tenderhepatomegaly,Hepatojugularreflux,lowerextremityedema,ascites.

ClinicalManifestationsDecompe8

Chestradiography：Enlargedrightdescendingpulmonaryarterydiameter

≥15mm;Theratioofdiameterofrightdescendingpulmonaryarterytotrachea≥1.07;Rightdescendingpulmonaryarterybroadens＞2mmduringdynamicobservationBulgeof

themiddlesegmentofpulmonaryarteryorwiththeheight≥3mmEnlargementofthepulmonaryarteriesandthemajorbranches,withmarkedtaperingofperipheralarteriesPulmonarycone

protrudesorwiththeheight≥7mmRightventricularhypertrophyLaboratoryassessmentChestradiography：Laborator9肺心病英文-內(nèi)科學(xué)課件10Electrocardiography：

Maincriteria:Meanfrontalplaneelectricalaxis≥90°V1R/S≥1Markedclockwiserotationoftheelectricalaxis：V5R/S≤1Rv1+Sv5＞1.05mVaVRR/SorR/Q≥1V１~Ｖ３:QS,Qr,qr（excludingmyocardialinfarction）P-pulmonale(tallpeakedPwavesinleadII)Secondarycriteria:LowvoltageQRSwaveformsinlimbleadsRightbundlebranchblockLaboratoryassessmentElectrocardiography：Laboratory11肺心病英文-內(nèi)科學(xué)課件12

EchocardiographyTheinnerdiameterofrightventricularoutflow≥30mmTherightventricularinternaldimension≥20mmAnteriorrightventricularwallthickened,orwiththepulsationamplitudeincreaseRatiooflefttorightventricularinternaldimension<2Increasedinnerdiameterofrightpulmonaryartery≥18mmorpulmonaryarterytrunk≥20mmRatioofrightventricularoutflowinnerdiametertoleftatriuminternaldimension＞1.4PulmonaryvalvecurveshowsthehypertentionofpulmonarycirculationLaboratoryassessmentEchocardiographyLaboratoryas13VectorcardiogramMoresensitivethanECG：positiverate80-95%Graphicshowthehypertrophyofrightheart

Arterialbloodgasanalysis:

Hypoxemiaand/orhypercapniaRespiratoryfailure:PaO2＜60mmHg

PaCO2＞50mmHg

Bloodtest:

Acid-baseandelectrolyteimbalanceBloodviscosity

↑RBCcountandhemoglobin↑WBCcountandneutrophilicratio↑wheninfectionoccursLaboratoryassessmentVectorcardiogramLaboratorya14MedicalhistoryofCOPDandotherlungorpulmonaryvasculardiseases.Symptomsandsignsofprimarydisease,pulmonaryhypertension,rightventricularhypertrophyordysfunctionofrightheartLabfindings:EKG;X-ray;UCG,etal.Diagnosis

MedicalhistoryofCOPDandot15DifferentialdiagnosisCoronaryheartdiseasePrimarycardiomyopathyRheumaticheartdiseaseCyanoticcongenitalheartdiseaseDifferentialdiagnosisCoronary16CompensationstageTreatmentofprimarydiseaseEliminatethepredisposingfactors,avoidtheacuteexacerbationtorestoretheheartandlungfunction

TreatmentCompensationstageTreatment17DecompensationstageTreatmentofrespiratoryfailureTreatmentofrightheartfailureTreatmentDecompensationstageTreatment18Treatmentofrespiratoryfailure

AntimicrobialtreatmentBronchodilators,expectorantsSputumaspiration,airwaymaintenanceOxygentherapyCorrecttheacid-baseandelectrolyteimbalanceTreatmentTreatmentofrespiratoryfailu19TreatmentofrightheartfailureOxygentherapy,infectioncontrolandthemeasurestoimproverespiratoryfunctioncanamelioratethethesymptomsofheartfailureinmostcasesAppropriatediuretics,cardiotonicsandvasodilatorscanbechosenwhenthetreatmentsmentionedabovefailsTreatmentTreatment20TreatmentofrightheartfailureDiuretics:Principle:Combinepotassium-sparingdiureticsandthediureticsthatdischargespotassium;Lowdosage,shortperiodandintermittentuse.Treatmentofrightheartfailu21TreatmentofrightheartfailureCardiotonics:

Principle:Lowdosage,rapideffectandexcreted(cedilanid,strophanthinK),correctionofhypoxiaandhypokalemiabeforeuse.Indications:①Heartfailurecan’tbeimprovedafterinfectioncontroled,respiratoryfunctionimprovedanddiureticsused②supraventriculartachyarrhythmia③Rightheartfailurewithoutacuteinfection④AcuteleftheartfailureTreatmentofrightheartfailu22TreatmentofrightheartfailureVasodilatorsDilatesthepulmonaryatery→pressureofpulmonaryatery↓

→

loadoftherightheart↓→improvethe

rightheartfunctionAdverseeffect:bloodpressure↓,bloodflowofcoronaryatery

↓,

ventilation/perfusionratio↓

→

hypoxemiaTreatmentofrightheartfailu23

TreatmentofComplicationsPulmonaryencephalopathyAcid-baseandelectrolytedisturbanceArrhythmia：atrialprematurecontractions,paroxysmalsupraventriculartachycardia,chaoticatrialtachycardiaisthemostspecificShockGastrointestinalhemorrhageDICTreatmentofComplicationsPul24謝謝！謝謝！258肺心病英文中山大學(xué)內(nèi)科學(xué)8肺心病英文中山大學(xué)內(nèi)科學(xué)26肺心病英文-內(nèi)科學(xué)課件27肺心病英文-內(nèi)科學(xué)課件28MechanismandPathology（一）Pulmonaryhypertension：Definition：meanpulmonaryarterypressure（mPAP）≥25mmHgatrestor≥30mmHgduringexercise.FunctionalchangesinpulmonaryvascularHypoxia,Hypercapnia,Respiratoryacidosis,vasoconstrictionsubstances→Pulmonaryvasoconstriction→PulmonaryhypertensionHypoxiaisthemostimportantfactorleadstopulmonaryhypertensionAnatomicchangesinpulmonaryvascularRemodelingofpulmonaryvesselsIncreasedbloodviscosityandbloodvolumeMechanismandPathology（一）Pulm29MechanismandPathology（二）Dysfunctionofrightheart

Pulmonaryhypertension→Afterloadofrightventricular

↑,Oxygensupplyofmyocardium↓→Hypertrophyanddilatationoftherightventricle→Rightheartfailure

(三）Damagestoothervitalorgans：

MultipleorgandysfunctionMechanismandPathology（二）Dysf30ClinicalManifestationsCompensationstageofcardiacandlungfunctionSymptoms:cough,sputum,shortofbreath;dyspneaandpalpitationonexertion;fatigueanddecreaseofexercisetolerance;exacerbatedbyacuteinfection.Signs:cyanosis,signsofemphysema,moistralesand/orrhonchi;P2>A2,systolicmurmuroftricuspidarea,subxiphoidvisible/palpablecardiacimpulse,distendedjugularvenous.ClinicalManifestationsCompens31ClinicalManifestationsDecompensationstageofcardiacandlungfunction

Respiratoryfailure

Symtoms:severedyspnea,especiallyatnight,headache,insomnia,inappetence,somnolence,dizziness,confusion,evendelirium.Signs:conjunctivacongestionandedema,retinalvasodilatation,opticpapillaryedema;weaknessordisappearofdeepreflexes,pathologicalreflexes.

ClinicalManifestationsDecompe32ClinicalManifestationsDecompensationstageofcardiacandlungfunction

RightheartfailureSymtoms:dyspneaaggravated,palpitation,inappetence,abdominaldistention,nausea.Signs:cyanosis,arrhythmia,tachycardia,subxiphoidsystolicmurmurorevendiastolicmurmur.Tenderhepatomegaly,Hepatojugularreflux,lowerextremityedema,ascites.

ClinicalManifestationsDecompe33

Chestradiography：Enlargedrightdescendingpulmonaryarterydiameter

≥15mm;Theratioofdiameterofrightdescendingpulmonaryarterytotrachea≥1.07;Rightdescendingpulmonaryarterybroadens＞2mmduringdynamicobservationBulgeof

themiddlesegmentofpulmonaryarteryorwiththeheight≥3mmEnlargementofthepulmonaryarteriesandthemajorbranches,withmarkedtaperingofperipheralarteriesPulmonarycone

protrudesorwiththeheight≥7mmRightventricularhypertrophyLaboratoryassessmentChestradiography：Laborator34肺心病英文-內(nèi)科學(xué)課件35Electrocardiography：

Maincriteria:Meanfrontalplaneelectricalaxis≥90°V1R/S≥1Markedclockwiserotationoftheelectricalaxis：V5R/S≤1Rv1+Sv5＞1.05mVaVRR/SorR/Q≥1V１~Ｖ３:QS,Qr,qr（excludingmyocardialinfarction）P-pulmonale(tallpeakedPwavesinleadII)Secondarycriteria:LowvoltageQRSwaveformsinlimbleadsRightbundlebranchblockLaboratoryassessmentElectrocardiography：Laboratory36肺心病英文-內(nèi)科學(xué)課件37

EchocardiographyTheinnerdiameterofrightventricularoutflow≥30mmTherightventricularinternaldimension≥20mmAnteriorrightventricularwallthickened,orwiththepulsationamplitudeincreaseRatiooflefttorightventricularinternaldimension<2Increasedinnerdiameterofrightpulmonaryartery≥18mmorpulmonaryarterytrunk≥20mmRatioofrightventricularoutflowinnerdiametertoleftatriuminternaldimension＞1.4PulmonaryvalvecurveshowsthehypertentionofpulmonarycirculationLaboratoryassessmentEchocardiographyLaboratoryas38VectorcardiogramMoresensitivethanECG：positiverate80-95%Graphicshowthehypertrophyofrightheart

Arterialbloodgasanalysis:

Hypoxemiaand/orhypercapniaRespiratoryfailure:PaO2＜60mmHg

PaCO2＞50mmHg

Bloodtest:

Acid-baseandelectrolyteimbalanceBloodviscosity

↑RBCcountandhemoglobin↑WBCcountandneutrophilicratio↑wheninfectionoccursLaboratoryassessmentVectorcardiogramLaboratorya39MedicalhistoryofCOPDandotherlungorpulmonaryvasculardiseases.Symptomsandsignsofprimarydisease,pulmonaryhypertension,rightventricularhypertrophyordysfunctionofrightheartLabfindings:EKG;X-ray;UCG,etal.Diagnosis

MedicalhistoryofCOPDandot40DifferentialdiagnosisCoronaryheartdiseasePrimarycardiomyopathyRheumaticheartdiseaseCyanoticcongenitalheartdiseaseDifferentialdiagnosisCoronary41CompensationstageTreatmentofprimarydiseaseEliminatethepredisposingfactors,avoidtheacuteexacerbationtorestoretheheartandlungfunction

TreatmentCompensationstageTreatment42DecompensationstageTreatmentofrespiratoryfailureTreatmentofrightheartfailureTreatmentDecompensationstageTreatment43Treatmentofrespiratoryfailure

AntimicrobialtreatmentBronchodilators,expectorantsSputumaspiration,airwaymaintenanceOxygentherapyCorrecttheacid-baseandelectrolyteimbalanceTreatmentTreatmentofrespiratoryfailu44TreatmentofrightheartfailureOxygentherapy,infectioncontrolandthemeasurestoimproverespiratoryfunctioncanamelioratethethesymptomsofheartfailureinmostcasesAppropriatediuretics,cardiotonicsandvasodilatorscanbec