内科学-肺心病.ppt

ChronicPulmonaryheartdisease复旦大学上海医科大学附属华山医院呼吸科张斯为

ChronicPulmonaryheartdisease

DefinitionItisdirectlycausedbychronicalterationsinpulmonarycirculationorchronicchestdiseasesthatleadtopulmonaryarterialhypertension,rightventricularenlargement,evenrightheartfailure.

Epidemiology70yearsmorbidity40y0.46%90yearsmorbidity15y0.70％，countycitynorthsouthmalefemalesmokenosmokeagednessyoung51－6041—50high2－3倍Differentcardiopathyinhospital5～35％

Etiology1.Bronchialandpulmonarydisorders：chronicbronchitiscomplicatedwithCOPD:80－90%asthma,bronchiectasis,tuberculosis,silicosis,chronicinterstitiallungdisease2.Disordersofchestmovement:（rare）abnormality,adhesion,vertebraltuberculosis、rheumatoidspondylitis。

Etiology3.Disordersofpulmonaryvessel:pulmonaryarterialhypertensionofunknowncauseHypersensitivegranuloma?embolismofpulmonaryartery4.other:DisordersofnerveandmusclePoliomyelitisdisordersofmotor-nervecenter

Pathology1).mainprimarydisordersoflungchronicbronchitisandemphysema2).changesofpulmonaryvesselsA.thewallofpulmonaryvesselsthickening,narrowing,orobliterativeB.capillarybedofalveolarwalldamaged,decreasedC.vascularbedoflungcompressedtobeirregular

Pathology3).changesoftheheartincreasedheartweighthypertrophyofrightventricleenlargementofrightventricle

pathogenesis

A.pulmonaryarterialhypertension1).organicchangesofpulmo