内科学 肺心病-张斯为【荐】.pptVIP

Chronic Pulmonary heart disease 复旦大学上海医科大学附属华 山医院呼吸科 张斯为 Chronic Pulmonary heart diseaseDefinition 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. Epidemiology 70 years morbidity 40y 0.46% 90 years morbidity 15y 0.70％， countycity north south malefemale smokeno smoke agednessyoung 51－6041—50 high 2－3倍 Different cardiopathy in hospital 5～35％ Etiology 1. Bronchial and pulmonary disorders： chronic bronchitis complicated with COPD: 80－90% asthma, bronchiectasis, tuberculosis, silicosis, chronic interstitial lung disease 2. Disorders of chest movement:（rare）abnormality,adhesion, vertebral tuberculosis、rheumatoid spondylitis 。 Etiology 3. Disorders of pulmonary vessel: pulmonary arterial hypertension of unknown cause Hypersensitive granuloma ? embolism of pulmonary artery 4. other: Disorders of nerve and muscle Poliomyelitis disorders of motor-nerve center 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 Pathology 3). changes of the heart increased heart weight hypertrophy of right ventricle enlargement of right ventricle pathogenesis A. pulmonary arteria