心臟病及保健 Heart Disease And Health http://心臟病.tw www.heartdisease.idv.tw
PULMONARY HEART DISEASE
Andrew Ying-Siu Lee, MD,PhD.
Pulmonary heart diseases are cardiovascular diseases due to disease processes affecting the pulmonary
parenchyma or vessels. The common pulmonary heart diseases are :-
(1) PULMONARY HYPERTENSION :-
Pulmonary hypertension results from decrease in caliber of pulmonary vessels and /or increase in pulmonary
blood flow, when the pulmonary artery systolic and mean pressures > 30 and 20 mmHg, respectively.
(a) Primary pulmonary hypertension:
Pulmonary hypertension of unexplained etiology, probably due to abnormality in pulmonary vessels
or development of thrombi.
(b) Secondary pulmonary hypertension:
Etiology include: (1) left ventricular diastolic failure (hypertension, aortic stenosis, coronary artery
disease, constrictive pericarditis, cardiomyopathies etc), (2) left atrial hypertension (mitral stenosis
or regurgitation, heart tumors etc), (3) pulmonary diseases (chronic obstructive pulmonary diseases,
pulmonary fibrosis, interstitial lung disease etc), (4) pulmonary thromboembolism, collagen diseases,
pulmonary stenosis, congenital heart diseases, chronic hepatic diseases, contraceptives, obesity,
hereditary, hypoxia etc..
Symptoms of pulmonary hypertension include: dyspnea, weakness, dizziness, fainting, cyanosis,
chest discomfort, edema, arrhythmias. Therapy of pulmonary hypertension include vasodilators and
anticoagulants. If medical treatment is not successful, heart-lung transplantation may be considered.
Prognosis is poor, cause of death usually due to right heart failure or sudden cardiac death.
(2) PULMONARY EMBOLISM :-
Pulmonary embolism occurs when thrombi formation elsewhere in the body embolize to the pulmonary
vessels causing complete or partial occlusion. Majority of pulmonary embolism come from thrombi formation
at iliofermoral veins, known as deep venous thrombosis. Minority come from right heart chambers. Non-thrombus
pulmonary embolism include: air, amniotic fluid, fat etc. Precipitating factors include: immobilization (trauma,
severe chronic diseases), hypercoagulable status (local trauma to vessel wall, hypercoagulability, stasis), obesity,
old age, cancer, contraceptives, pregnancy, post-partum, stroke, spinal cord injury, heart failure etc .
Symptoms are not obvious. Small pulmonary embolism usually has no symptom. Large pulmonary
embolism may elicit sudden onset of dyspnea, pleuritic chest pain, hemoptysis, dizziness, fainting, right heart
failure, shock, sudden cardiac death. Diagnois include: chest X-ray, electrocardiogarm, echocardiography,
blood gas analysis, plasma d- dimmers, venous ultasound, contrast phlebography, lung scanning, pulmonary
angiography. Treatment include: oxygen, anticoagulants, thrombolytic agents, embolectomy, inferior vena
cava filter etc. Prognosis is good.
(3 ) COR PULMONALE :-
Cor pulmonale occurs when pulmonary diseases elicit pulmonary arterial hypertension and right heart
hypertrophy leading to right heart failure. Causes include: (1) chronic obstructive pulmonary diseases,
(2) interstitial pulmonary diseases, (3) upper airway obstruction (enlarged tonsils, macroglossia, tracheal stenosis,
sleep apnea syndrome), (4) chronic pulmonary thromboembolism, (5) chest wall discorders with poor ventilation.
Symptoms are secondary to the pulmonary arterial hypertension, right heart failure and the pulmonary
diseases per se. Common symptoms include: dyspnea, weakness, edema, cyanosis, chest pain etc. Diagnosis
include: blood gas analysis, chest X-ray, electrocardiogram, echocardiography, cardiac catheterization etc.
Therapy include: oxygen, bronchodilators, physical therapy, antibiotics, steroids, antifailure drugs etc. If medical
treatment is not successful, heart-lung transplantation may be considered. Prognosis is bad is right heart failure occurs.