慢性肺心病幻灯片教学讲义.pptVIP

Chronic Pulmonary Heart Disease;OUTLINE;Etiology;Mechanism and Pathology;Mechanism and Pathology;Clinical Manifestations;Clinical Manifestations;Clinical Manifestations; Chest radiography： Enlarged right descending pulmonary artery diameter ≥15mm ; The ratio of diameter of right descending pulmonary artery to trachea≥1.07 ; Right descending pulmonary artery broadens＞2mm during dynamic observation Bulge of the middle segment of pulmonary artery or with the height≥3mm Enlargement of the pulmonary arteries and the major branches, with marked tapering of peripheral arteries Pulmonary cone protrudes or with the height≥7mm Right ventricular hypertrophy ;;Vectorcardiogram More sensitive than ECG：positive rate 80-95% Graphic show the hypertrophy of right heart Arterial blood gas analysis : Hypoxemia and/or hypercapnia Respiratory failure: PaO2＜60mmHg PaCO2＞ 50mmHg Blood test: Acid-base and electrolyte imbalance Blood viscosity ↑ RBC count and hemoglobin ↑ WBC count and neutrophilic ratio ↑when infection occurs ;Medical history of COPD and other lung or pulmonary vascular diseases. Symptoms and signs of primary disease, pulmonary hypertension, right ventricular hypertrophy or dysfunction of right heart Lab findings:EKG;X-ray;UCG,et al.;Differential diagnosis;Compensation stage Treatment of primary disease Eliminate the predisposing factors ,avoid the acute exacerbation to restore the heart and lung function ;Decompensation stage Treatment of respiratory failure Treatment of right heart failure ;Treatment of respiratory failure Antimicrobial treatment Bronchodilators, expectorants Sputum aspiration, airway maintenance Oxygen therapy Correct the acid-base and electrolyte imbalance ; Treatment of right heart failure Oxygen therapy, infection control and the measures to improve respiratory function can ameliorate the the symptoms of heart failure in most cases Appropriate diuretics, cardiotonics and vasodilators can be chosen when the treat