肺性心 cor pulmonale、肺心症

WordNet

a plane figure with rounded sides curving inward at the top and intersecting at the bottom; conventionally used on playing cards and valentines; "he drew a heart and called it a valentine"
the courage to carry on; "he kept fighting on pure spunk"; "you havent got the heart for baseball" (同)mettle, nerve, spunk
an inclination or tendency of a certain kind; "he had a change of heart" (同)spirit
a playing card in the major suit that has one or more red hearts on it; "he led the queen of hearts"; "hearts were trumps"
the locus of feelings and intuitions; "in your heart you know it is true"; "her story would melt your bosom" (同)bosom
the hollow muscular organ located behind the sternum and between the lungs; its rhythmic contractions move the blood through the body; "he stood still, his heart thumping wildly" (同)pump, ticker
a firm rather dry variety meat (usually beef or veal); "a five-pound beef heart will serve six"
able to perceive sound
an opportunity to state your case and be heard; "they condemned him without a hearing"; "he saw that he had lost his audience" (同)audience
(law) a proceeding (usually by a court) where evidence is taken for the purpose of determining an issue of fact and reaching a decision based on that evidence
the ability to hear; the auditory faculty; "his hearing was impaired" (同)audition, auditory sense, sense of hearing, auditory modality
a session (of a committee or grand jury) in which witnesses are called and testimony is taken; "the investigative committee will hold hearings in Chicago"
receive a communication from someone; "We heard nothing from our son for five years"
examine or hear (evidence or a case) by judicial process; "The jury had heard all the evidence"; "The case will be tried in California" (同)try
perceive (sound) via the auditory sense
an impairment of health or a condition of abnormal functioning
caused by or altered by or manifesting disease or pathology; "diseased tonsils"; "a morbid growth"; "pathologic tissue"; "pathological bodily processes" (同)morbid, pathologic, pathological

PrepTutorEJDIC

〈C〉『心臓』;胸 / 〈C〉(感情の中心をなす)『心』,気持ち / 〈U〉愛情,同情 / 〈U〉『勇気』,元気,熱意 / 《the ~》『中心』,内部,(物事の)本質,核心 / 〈C〉ハート形の物;(カードの)ハートの札
〈U〉『聴力』,聴覚〈U〉〈C〉(…を)『聞くこと』,(…の)聞き取り《+『of』+『名』》・〈C〉聞いてもらう機会,聞いてやること・聴取・聴聞会〈C〉(法廷などでの)尋問,審問,;(刑罰の減免を求める)釈明,意見陳述 / 〈U〉聞こえる距離(範囲)
〈音〉‘が'『聞こえる』,‘を'聞く(進行形にできない) / 〈人の言うこと〉‘に'『耳を傾ける』,‘を'注意深く聞く(listen);(裁判官などが)…の申し立てを聞く / 〈うわさ・ニュースなど〉‘を'『耳にしている』,聞いている / 『耳が聞こえる』 / 《しばしば命令形で》耳を傾ける,注意を向ける / 『うわさ』(『消息』)『を聞く』
(体の)『病気』,疾患 / (精神・道徳などの)病気,病弊
女性の話術芸人 =diseur
病気にかかった / 病的な,不健全な(morbid)

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/07/05 02:27:14」(JST)

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Right ventricular hypertrophy

Pulmonary heart disease (New Latin pulmōnāle, of the lungs), also known as Cor pulmonale (Latin cor, heart + of the lungs) is the enlargement and failure of the right ventricle of the heart as a response to increased vascular resistance or high blood pressure in the lungs (pulmonary hypertension).

Chronic pulmonary heart disease usually results in right ventricular hypertrophy (RVH), whereas acute pulmonary heart disease usually results in dilatation. Hypertrophy is an adaptive response to a long-term increase in pressure. Individual muscle cells grow larger (in thickness) and change to drive the increased contractile force required to move the blood against greater resistance. Dilatation is a stretching (in length) of the ventricle in response to acute increased pressure, such as when caused by a pulmonary embolism or ARDS (acute respiratory distress syndrome).

To be classified as pulmonary heart disease, the cause must originate in the pulmonary circulation system. Two major causes are vascular changes as a result of tissue damage (e.g. disease, hypoxic injury, chemical agents, etc.), and chronic hypoxic pulmonary vasoconstriction. If left untreated, then death may result. RVH due to a systemic defect is not classified as pulmonary heart disease.

The heart and lungs are intricately related. Whenever the heart is affected by disease, the lungs will follow and vice versa. Pulmonary heart disease is by definition a condition when the lungs cause the heart to fail.^[1]

The heart has two pumping chambers. The left ventricle pumps blood throughout the body. The right ventricle pumps blood to the lungs where it is oxygenated and returned to the left heart for distribution. In normal circumstances, the right heart pumps blood into the lungs without any resistance. The lungs usually have minimal pressure, and the right heart easily pumps blood through to them.^[2] However with certain lung diseases chronically present, like emphysema and chronic bronchitis, each of which is found in the pathology of chronic obstructive pulmonary disease (COPD), and also pulmonary hypertension, the blood vessels of the lungs are significantly reduced in number (due to lung tissue destruction) and/or chronically constricted (due to poor alveolar ventilation in the case of COPD). The right ventricle is no longer able to push blood into the lungs effectively, and the chronic overload eventually causes it to fail.

Signs and symptoms

The symptoms of pulmonary heart disease depend on the stage of the disorder. In the early stages, one may have no symptoms but as pulmonary heart disease progresses, most individuals will develop the symptoms like:

Shortness of breath which occurs on exertion but when severe can occur at rest
Wheezing
Chronic wet cough
Swelling of the abdomen with fluid (ascites)
Swelling of the ankles and feet (pedal edema)
Enlargement or prominent neck and facial veins
Raised jugular venous pressure (JVP)
Enlargement of the liver
Bluish discoloration of the skin (cyanosis)
Presence of abnormal heart sounds
possible bi-phasic atrial response shown on an EKG due to hypertrophy

Complications

Blood backs up into the systemic venous system, including the hepatic vein. Chronic congestion in the centrilobular region of the liver leads to hypoxia and fatty changes of more peripheral hepatocytes, leading to what is known as nutmeg liver.

Causes

Acute:
- Pulmonary embolism
- Acute respiratory distress syndrome (ARDS)
Chronic:
- COPD
- Primary pulmonary hypertension
- Uncontrolled persistent asthma
- Loss of lung tissue following trauma or surgery
- Pierre Robin sequence
- End stage pneumoconiosis
- Sarcoidosis
- T1-4 Vertebral subluxation
- Obstructive sleep apnea(untreated)
- Interstitial lung disease
- Sickle cell anemia
- Bronchopulmonary dysplasia (in infants)
- Severe thoracic kyphosis

Diagnosis

Normal heart (left) and right ventricular hypertrophy (right)

In many cases, the diagnosis of pulmonary heart disease is not easy as both the lung and heart disease can produce similar symptoms. Most patients undergo an electrocardiogram, chest x ray, echocardiogram, CT scan of the chest and a cardiac catheterization. During a cardiac catheterization, a small flexible tube is inserted from the groin and under x-ray guidance images of the heart are obtained. Moreover the technique allows measurement of pressures in the lung and heart which provide a clue to the diagnosis.^[1]

Chest x ray – right ventricular hypertrophy, right atrial dilatation, prominent pulmonary artery – Peripheral lung fields show reduced vascular markings. Patients of chronic obstructive pulmonary disease show features of hyperinflation that include widened intercostal space, increased translucency of lung and flattened diaphragm.
ECG – right ventricular hypertrophy, right axis deviation, prominent R wave in lead V1 & inverted T waves in right precordial leads, Large S in Lead I, II and III; Large Q in lead III, Tall Peaked P waves (P pulmonale) in lead II, III and aVF – Not all the above features are found in a single patient; however, different patients show different combinations of these findings.
Echocardiogram – right ventricular hypertrophy or dilatation, possible tricuspid regurgitation expected

Pathophysiology

There are several mechanisms leading to pulmonary hypertension and pulmonary heart disease:

Pulmonary vasoconstriction
Anatomic changes in vascularization
Increased blood viscosity
Idiopathic or primary pulmonary hypertension

Prevention

While not all lung diseases can be prevented one can reduce the risk of lung disease. This means avoiding or discontinuing smoking. Patients with end stage emphysema or chronic obstructive lung disease always end up with right heart failure. When working in environments where there are chemicals, wear masks to prevent inhalation of dust particles.^[3]

Treatment

Elimination of the cause is the most important intervention. Smoking must be stopped, along with exposure to second-hand smoke. Exposure to dust, flames, household smoke and to cold weather are to be avoided. If there is evidence of respiratory infection, it should be treated with appropriate antibiotics after culture and sensitivity. In pulmonary embolism, thrombolysis (enzymatic dissolution of the blood clot) is advocated by some authorities^[who?] if there is dysfunction of the right ventricle, and is otherwise treated with anticoagulants. In COPD, long-term oxygen therapy may improve pulmonary heart disease.

Pulmonary heart disease may lead to congestive heart failure (CHF), with worsening of respiration due to pulmonary edema, swelling of the legs due to peripheral edema and painful congestive hepatomegaly (enlargement of the liver due to tissue damage). This situation requires diuretics (to decrease strain on the heart), sometimes nitrates (to improve blood flow), phosphodiesterase inhibitors such as sildenafil or tadalafil and occasionally inotropes (to improve heart contractility). CHF is a negative prognostic indicator in pulmonary heart disease.

Oxygen is often required to resolve the shortness of breath. Plus, oxygen to the lungs also helps relax the blood vessels and eases right heart failure. Oxygen is given at the rate of 2 litres per minute. Excess oxygen can be harmful to patients because hypoxia is the main stimulus to respiration. If such hypoxia is suddenly corrected by overflow of oxygen, such stimulus to the respiratory center is suddenly withdrawn and respiratory arrest occurs. When wheezing is present, majority of the patients require bronchodilators. A variety of drugs have been developed to relax the blood vessels in the lung. Calcium channel blockers are used but only work in a few cases. Other novel medications that need to be inhaled or given intravenously include prostacyclin derivatives.

Cases of COPD with chronic pulmonary heart disease present with secondary polycythemia, and if severe it may increase the blood viscosity and contribute to pulmonary hypertension. If hematocrit (PCV) is above 60%, then it is better to reduce the red blood cell count by phlebotomies.

Mucolytic agents like bromhexine and carbocisteine help bring out excessive bronchial secretions more easily by coughing.

All patients with pulmonary heart disease are maintained on blood thinning medications to prevent formation of blood clots.

When medical therapy fails, one may require a transplant. However, since the lungs are damaged, both the heart and lungs needs to be transplanted. With a shortage of donors this therapy is only done 10-15 times a year in North America.

Epidemiology

Each year there are about 20,000 deaths and close to 280,000 hospital admissions among individuals who have pulmonary heart disease. The majority of individuals affected by pulmonary heart disease are women less than 65 years of age. Infants who are born with congenital heart disorders (esp. holes in the heart like a VSD) are prone to pulmonary artery disease. While pulmonary heart disease is serious, it is much less common than coronary artery disease.^[2]

References

^ ^a ^b American Medical Network - Pulmonary Heart Disease, Retrieved on 2010-01-25.
^ ^a ^b Pulmonary Heart Disease Information, Retrieved on 2010-01-25.
^ Living With Pulmonary Heart Disease, Retrieved on 2010-01-25.

External links

Emedicine
The Merck Manual of Diagnosis and Therapy: Cor Pulmonale

UpToDate Contents

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Management of the advanced heart failure patient can be complex. Therapies include cardiac transplantation and mechanical circulatory support, as well inotropic agents for the short-term. Despite a growing armamentarium of resources, the clinician must carefully weigh the risks and benefits of each
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