Chronic pulmonary heart (HPS) involves hypertrophy (enlargement) and / or dilation (widening) of the right ventricle as a result of functional and structural diseases of the lungs and pulmonary vascular networks.
Epidemiology
It occurs on average about 10% of all cases of coronary heart disease. HPS is 5 times more often in men than in women.
Etiology:
All causative diseases that cause HPS are divided into three groups:
First Diseases that primarily damage the airways and lung alveoli - chronic bronchitis, bronchial asthma, emphysema, pulmonary fibrosis, pulmonary granulomatosis, lung resection, congenital cystic lung, hypoxia due to high altitude.
Second Diseases that damage the movements of the chest - kyphoscoliosis, torakoplastika, pleural fibrosis, polio, Pickwickian syndrome.
Third Diseases that damage the vascular network of primary lung - primary arterial wall damage, primary pulmonary thrombosis, sickle cell anemia, embolism, pressure, mediastinal tumor, aneurysm (enlargement) or fibrosis of the pulmonary artery and vein.
The development of HPS major role played by many factors aggravating the environment (exposure to dust, gas inhalation irritation, and exposure to high atmospheric temperature variations), frequent respiratory infections and poor economic conditions of life. Special attention is given great importance of constant irritant effects of tobacco smoke in smokers.
The clinical picture
Clinical picture of HPS is a combination of clinical features of primary lung and images hypertrophy and right heart failure. Contract most often middle aged men, farmers, manual workers in bad working conditions, and smokers in poor social conditions. In the long history of cough stress from 5 to 10 years and longer, with scant mucous sputum expectoration and sometimes purulent sputum. How to develop right heart failure patients by state and fatigue, and suffocation (dyspnea) in severe physical effort in the further course and the usual daily effort. In patients, the observed red conjunctiva (conjunctiva), red, moist, warm skin, with podbulošću face and protrusion of the eyeballs, which gives the patient the appearance of frogs. The chest is barrel-shaped, easy breathing rapidly (tachypnea), and signs are common and central cyanosis (blue painted tongue) and drumstick fingers. Jugular vein (Vv. jugulares) are swollen, and when right heart failure is worse you can see the edema of the legs and signs of ascites (fluid in the abdomen).
Diagnosis
It is based on history, physical examination, x-ray findings, ECG, ehokardigrafije (ultrasound) and cardiac catheterization. In patients with hypoxia is secondary polycythemia (increased numbers of blood cells), high hematocrit, slow sedimentation and increased levels of bicarbonate.
Treatment
The basic principle of treatment of HPS consists of right heart function improvement, timely treatment and improve lung function, improvement of arterial hypoxia and reduction of pulmonary hypertension. For this purpose, shall apply to the period of acute deterioration of right heart to give a smaller concentration of oxygen and aminophylline. Expressed in right heart failure should be given diuretics, almost regularly and digitalis glycosides to improve the contractile strength of weakened right ventricle. Favorably effect and vasodilators-nifedipine (calcium channel blocker) and hydralazine. In severe cases it can be done polycytemia venipuncture.
Prevention
It is implemented early and vigorous treatment of lung infections. Compulsory vaccination against influenza. No smoking.
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