慢性肺心病演示教学.pptVIP

Chronic Pulmonary Heart Disease;OUTLINE;Etiology;Mechanism and Pathology;Mechanism and Pathology;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 ;;Electrocardiography： Main criteria : Mean frontal plane electrical axis ≥90° V1 R/S≥1 Marked clockwise rotation of the electrical axis： V5 R/S≤1 Rv1+Sv5 ＞1.05mV aVR R/S or R/Q≥1 V１~Ｖ３:QS, Qr, qr（excluding myocardial infarction） P-pulmonale (tall peaked P waves in lead II) Secondary criteria : Low voltage QRS waveforms in limb leads Right bundle branch block ;; Echocardiography The inner diameter of right ventricular outflow ≥ 30 mm The right ventricular internal dimension ≥20mm Anterior right ventricular wall thickened ,or with the pulsation amplitude increase Ratio of left to right ventricular internal dimension 2 Increased inner diameter of right pulmonary artery ≥18mm or pulmonary artery trunk≥20mm Ratio of right ventricular outflow inner diameter to left atrium internal dimension ＞1.4 Pulmonary valve curve shows the hypertention of pulmonary circulation ;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,