Chronic pulmonary heart (HPS) involves hypertrophy (enlargement), and / or dilation (expansion) of the right ventricle as a result of structural and functional lung disease and pulmonary vascular network.
Frequency
It occurs on average at about 10% of all cases of heart disease. HPS is 5 times more common in men than in women.
The cause of
All causative diseases that cause HPS are divided into three groups:
• Diseases that primarily damage lung airways and alveoli - chronic bronchitis, bronchial asthma, emphysema, pulmonary fibrosis, pulmonary granulomatosis, lung resection, congenital cystic lung hypoxia due to high altitude
• Diseases that damage the movements of the chest - kyphoscoliosis, torakoplastika, pleural fibrosis, polio, Pickwickian syndrome
• Diseases that damage the vascular network of primary lung - the primary damage to the arterial wall, primary pulmonary thrombosis, sickle cell anemia, embolism, pressure mediastinal tumors, aneurysms (enlargement) or fibrosis pulmonary arteries and veins.
In the development of HPS play a major role and many aggravating factors of environment (exposure to dust, gases nadražajnih inhalation, and exposure to high atmospheric temperature fluctuations), frequent respiratory infections and poor economic conditions of life. In particular there is a great importance of constant irritant effects of cigarette smoke in smokers.
The clinical picture
The clinical picture of HPS is a combination of the clinical picture of primary lung and images hypertrophy and right heart failure. Frequently suffer middle aged men, farmers, laborers in the harshest conditions, and, smokers in poor social conditions. In the long history of stress cough from 5 to 10 years or longer, with mucous expectoration of sputum scarce and sometimes purulent sputum. How to develop right heart failure patients by state and fatigue and suffocation in severe physical exertion, and with the further course of the daily efforts. In patients noticed redness conjunctiva (conjunctiva), red, moist and warm skin, with podbulošću face and eyeball protrusion of the patient gives frog appearance. The chest was barrel-shaped, breathing easily and rapidly frequent signs and central cyanosis (blue discoloration of tongue) and maljičasti fingers. Jugular veins are swollen and right heart failure izaraženijoj see the islands on their feet and signs of ascites (presence of fluid in the abdomen).
Diagnosis
It is based on history, physical examination, x-ray, ECG's, ehokardigrafije (ultrasound) and cardiac catheterization. In patients with hypoxia is polycythemia (increased number of blood cells), high hematocrit, slow sedimentation and increased levels of bicarbonate.
Treatment
The basic principle of treatment HPS consists of improving the function of the right heart, and timely treatment to improve lung function, improve arterial hypoxia and reduction of pulmonary hypertension. In order to apply this: the period of acute deterioration of right heart to give less concentration of oxygen and aminophylline. The pronounced right heart failure should be given diuretics, almost always given digitalis and to repair weakened contractile force of the right ventricle.Favorably effect and vasodilators nifedipine and hydralazine-. In severe cases it can be done venipuncture.
Prevention
Implemented early and vigorous treatment of lung infections. Compulsory vaccination against influenza. No smoking.
