西安交通大学医学院呼吸系统疾病课件 Chronic Cor Pulmonale.pptVIP

Chronic Cor Pulmonale Respiratory department Chen Mingwei Chronic cor pulmonale is defined as right heart hypertrophy and/or chronic right heart failure that is secondary to pulmonary hypertension that results from mostly COPD. Etiology Bronchopulmonary disorders Thoracic disorders Pulmonary circulating disorders Pathophysiology 1. Pulmonary Arterial Hypertension (PAH) is defined operationally as mean pulmonary arterial pressure 20 mmHg at rest or 30 mmHg with exercise. 2. Right Ventricular Failure The outline of right ventricular failure due to PAH is described briefly as follows: Causes ? Pulmonary vascular resistance ? PAH ? Hypertrophy of right ventricle ? Dilation of right ventricle ? Right Heart Failure Clinical Features The symptoms of chronic cor pulmonale develop gradually over years. Besides manifestations due to underlying disorders, signs of respiratory failure, cardiac failure or even other organs impared may gradually occur. Compensation of respiratory function and cardiac function Decompensation of respiratory function and cardiac function Accessory Findings Chest Radiograph CT and Magnetic Resonance Imaging (MRI) ECG Echocardiography Right Heart Catheterization Arterial Blood Gas Analysis Accessory Findings Chest Radiograph a. Signs of underlying diseases such as hyperinflation may indicate the presence of emphysema or obstructive disease. Skeletal abnormalities can be identified as well. And infiltration within lung suggests acute exacerbation of COPD. b. Signs of pulmonary artery hypertension Any one of the signs as follows is the criteria for diagnosis: The width of the right descending pulmonary artery is 15 mm. The height of segmental pulmonary artery is 3 mm. Dilation of central pulmonary artery with fine peripheral branches. pulmonary conus protrution or height (in right anterior oblique position) is 7 mm Enlarged right ventricle Accessory Findings CT and Magnetic Resonance Imaging (MRI) CT can be used to de