复旦大学附属中山医院：《内科学》课程教学资源（PPT讲稿）张斯为－肺心病 Chronic Pulmonary heart disease

Chronic Pulmonary heart disease L Definition It is directly caused by chronic alterations in pulmonary circulation or chronic chest diseases that lead to pulmonary arterial hypertension, right ventricular enlargement, even right heart failure

Chronic Pulmonary heart disease 1.Definition It is directly caused by chronic alterations in pulmonary circulation or chronic chest diseases that lead to pulmonary arterial hypertension, right ventricular enlargement, even right heart failure

2.Etiology A. Bronchial and pulmonary disorders chronic bronchitis complicated with COPD 80-90% asthma, bronchiectasis, tuberculosis, silicosis, chronic interstitial lung disease B. Disorders of chest movement: (rare) abnormality, adhesion, vertebral tuberculosis rhumatoid spondylitis

2.Etiology A. Bronchial and pulmonary disorders： chronic bronchitis complicated with COPD: 80－90% asthma, bronchiectasis, tuberculosis, silicosis, chronic interstitial lung disease B. Disorders of chest movement:（rare） abnormality, adhesion, vertebral tuberculosis、 rhumatoid spondylitis

2.Etiology C. Disorders of nerve and muscle Poliomyelitis disorders of motor -nerve center D. Disorders of pulmonary vessels Hypersensitive granuloma embolism of pulmonary artery E. pulmonary arterial hypertension of unknown cause

2.Etiology C. Disorders of nerve and muscle Poliomyelitis disorders of motor-nerve center D. Disorders of pulmonary vessels Hypersensitve granuloma → embolism of pulmonary artery E. pulmonary arterial hypertension of unknown cause

3. Pathology 1) main primary disorders of lung chronic bronchitis and emphysema 2). changes of pulmonary vessels A. the wall of pulmonary vessels thickening, narrowing, or obliterative B. capillary bed of alveolar wall damaged, decreased C. vascular bed of lung compressed to be irregular

3.Pathology 1). main primary disorders of lung chronic bronchitis and emphysema 2). changes of pulmonary vessels A. the wall of pulmonary vessels thickening, narrowing, or obliterative B. capillary bed of alveolar wall damaged , decreased C. vascular bed of lung compressed to be irregular

3. Pathology 3). changes of the heart increased heart weight hypertrophy of right ventricle enlargement of right ventricle

3.Pathology 3). changes of the heart increased heart weight hypertrophy of right ventricle enlargement of right ventricle

4. Pathophysiology and pathogenesis

4. Pathophysiology and pathogenesis

A pulmonary arterial hypertension 1). organic changes of pulmonary vessels a thickening of the vessels b deterioration of emphysema c. Decreased capillary bed: >70% 2). functional changes of pulmonary vessels factors of body fluid, tissue and nerve

A. pulmonary arterial hypertension 1). organic changes of pulmonary vessels a. thickening of the vessels b. deterioration of emphysema c. Decreased capillary bed:>70% 2). functional changes of pulmonary vessels factors of body fluid, tissue and nerve

3). remodeling of pulmonary vessels vasoconstriction of vessels hypertrophy of smooth muscle cell 4). increased blood volume and increased blood VISCOSI hypoxia→RBC↑→ blood viscosity个 → resistance of blood flow个

3). remodeling of pulmonary vessels vasoconstriction of vessels hypertrophy of smooth muscle cell 4). increased blood volume and increased blood viscosity hypoxia→ RBC  → blood viscosity  → resistance of blood flow 

B Changes of right heart function Load of right ventricle T and hypertrophy of right ventricle early stage: compensated acute exacerbation ; Incompetency cardiac output↓

Load of right ventricle  and hypertrophy of right ventricle early stage: compensated acute exacerbation :incompetency cardiac output  B. Changes of right heart function

C Impairment of the other important organs Brain, liver, kidney digestive canal, et al

C. Impairment of the other important organs Brain, liver, kidney digestive canal, et al