Acute pulmonary heart disease

Overview of acute pulmonary heart disease (acute corpulmonale) mainly due to or from the venous system Right into the heart of embolic pulmonary circulation, causing pulmonary trunk or branches of the extensive embolism, Simultaneously with extensive pulmonary artery spasm, pulmonary circulation blocked, pulmonary artery pressure arising from the dramatic increase in right ventricular expansion and right heart failure. Cause pathogenesis most common in severe pulmonary embolism (pulmonary embolism). The main source of emboli : ① peripheral venous thrombosis : a deep vein and pelvic vein thrombosis or thrombophlebitis of the shedding of thrombosis common, such as pelvic inflammatory disease. Abdominal surgery and childbirth also promote local venous thrombosis and thrombophlebitis of the important reasons; ② right heart thrombosis : If long-term atrial fibrillation right atrium of the mural thrombus. pulmonary valve endocarditis at the notion of practically biological shedding may cause pulmonary embolism; ③ embolus : cancer cells can activate blood coagulation system have the material (such as protein, and protease cathepsin) which led to the hypercoagulability, resulting in thrombosis, the malignant tumor thrombus can be peeled off; ④ fat embolism : Unit tibia, and other long-bone fractures were caused by the most common, in addition to severe trauma can often occur chylomicrons gather induced lipid hyperinsulinemia, Shuan caused fat; ⑤ other : such as cardiovascular surgery, renal angiography weeks of air, such as artificial pneumoperitoneum due to improper operation. Air entering or right ventricular cavity caused by venous air embolism; pregnancy or childbirth in amniotic fluid embolism; Acute parasitic diseases adult or a large number of eggs into the pulmonary circulation and large amounts of pulmonary embolism. Pulmonary artery pressure may cause sharp increased incidence of acute right ventricular failure. Pathogenesis and pathological pulmonary thrombosis run to the right pulmonary circulation of size, depending on the site of vascular occlusion, area, pulmonary circulation original reserve capacity pulmonary vascular spasm and the extent to which. When both sides of the main pulmonary artery branches were suddenly huge clot embolic disease and blood clots surface of the platelet release collapse of the humoral Factors such as histamine and 5-HT, a variety of prostaglandin and thromboxane A2, and so on into the pulmonary circulation, can cause extensive pulmonary artery spasm, or because of the large number of small pulmonary emboli simultaneous arterial pulmonary embolism caused obstruction cross sectional area of more than half, open to a sharp rise in pulmonary arterial pressure, right ventricular blood Pai disruption occurred right ventricular dilatation and right ventricular failure. It may return in the reduction of left ventricular and left sudden cardiac output reduction, blood pressure drop, coronary insufficiency affect left ventricular function. Performance of a clinical symptoms when large or multiple pulmonary embolism, a sudden flu patients often difficulty in breathing, chest tightness, palpitations and suffocation flu, have severe cough or cough or dark red blood sputum. Have moderate fever, chest pain, chest pain when stimulate the diaphragm can be radiated to the shoulder, chest pain can sometimes similar to angina, likely caused by coronary artery spasm insufficiency. In serious cases, patients irritability, anxiety, cold sweats, nausea, vomiting, fainting, blood pressure dropped dramatically even shock, incontinent or even death. 2, signs extensive lesions may have cyanosis. Bulk pulmonary infarction voiced spontaneous delivery, breathing accompanied by the sound of weakening or dry, moist Rale. If pleural lesions, pleural friction may arise Xeno signs of pleural effusion. Increasing the heart rate, heart voiced sector expanded sternum left edge of the first two, three intercostal space voiced sector widened, pulsatile increase, Second pulmonary valve heart sounds hyperthyroidism, and systolic and diastolic murmur. Tricuspid District also have systolic and diastolic murmur Benma law. Have arrhythmia, such as atrial and ventricular premature beats, atrial flutter and fibrillation, cardiac arrest can occur. Right heart failure, the jugular vein engorgement, hepatomegaly and tenderness, jaundice may appear, double-leg edema. Some patients may have thrombophlebitis of the signs. Laboratories and other screening a blood screening blood leukocyte count can be normal or higher, increased ESR. Serum lactate dehydrogenase often higher serum bilirubin can be increased. 2, ECG and cardiac vector examination typical ECG changes often said axis significantly right side, extremely smooth bell to switch places and right bundle branch block. I lead deep S wave, ST-segment depression, III leads Q-wave visible and T-wave inversion, was SI QIIT Ⅲ wave, aVF showed T-wave morphology and similar Ⅲ lead, lead aVR R wave often increased heart before District leads V1, V2T wave inversion, P wave height and sharp pulmonary P wave. ECG QRS vector chart shows the Central Electricity starting left slightly forward slightly upward, then QRS main mainly upward right, After the transfer, there is a clear right to the end-ring, but no more delay in transmission performance. T loop backwards, and to the left. P-Central is vertical, the amplitude increases. These ECG and cardiac vector map changes, the onset 5-24 there, With most of the improved conditions in a few days to resume. 3, X-ray examination lungs, there will be lower lobe oval or triangular infiltration shadow, and even the bottom of the pleura, Pleural effusion is also shadow. Pulmonary vascular shadow of the side and deepen the ipsilateral phrenic up. Bilateral multiple pulmonary embolism, similar to a shadow of its invasion of bronchopneumonia. Severe pulmonary patients, there will be the obvious highlight of the heart enlargement and the azygos vein and superior vena cava shadow widened. As a selective pulmonary angiography can accurately understand embolization locations and the scope for surgical therapy. Diagnosis based on sudden onset, severe chest pain, and pulmonary signs disproportionate difficulty in breathing, cyanosis and shock, especially in the long-term bed rest, surgery or after childbirth and in patients with heart failure, pulmonary hypertension with signs, EKG, Vector map ECG and X-ray inspection results can be diagnosed. Selective angiography of pulmonary embolism can be diagnosed and scope of the site. Huai severe pulmonary infarction myocardial infarction as well.