1, chronic pulmonary heart disease (referred to as pulmonary heart disease): refers to the heart disease caused by chronic bronchitis, emphysema and other chest diseases or cardiovascular pathology, with pulmonary hypertension, right heart enlargement and right heart insufficiency.
2, right heart insufficiency mainly manifests as jugular vein anger, hepatomegaly, pressure pain, positive hepatocervical reflux sign, lower limb swelling and increased venous pressure.
3, pulmonary hypertension, right heart enlargement diagnosis based on.
(1) Signs: systolic pulsation under the saber, hyperactive second heart sound in the pulmonary artery region (P2>A2), significantly enhanced heart sound in the tricuspid region compared to the apical region, or systolic murmur.
(2) X-ray diagnostic criteria
1) Dilated right inferior pulmonary artery: transverse diameter ≥ 15 mm; or ratio of transverse diameter of right inferior pulmonary artery to transverse diameter of bronchus ≥ 1.07; or widening of right inferior pulmonary artery by more than 2 mm compared with the original right inferior pulmonary artery by dynamic observation.
2) Moderate protrusion of the pulmonary artery segment or its height ≥3mm.
3) Dilated central pulmonary artery and slender peripheral branches, both forming a sharp contrast.
4)Significant convexity of the conus (right anterior oblique 45 ———0C) or vertebral height ≥7mm.
5)Enlarged right ventricle (judged in combination with different body positions)
(Only one of the above 1-5 items can be diagnosed)
(3) Electrocardiographic diagnostic criteria.
①Main condition.
Frontal mean electrical axis ≥ 90 —-o
V1-R/S≥1
Severe cis-clockwise translocation (V5R/S≤1)
RV1+SV5>1.05Mv
av R R/S or R/Q≥1
V1-V3 showing QS, Qr, qr (need to exclude myocardial infarction)
Pulmonary P-wave.
A, P-wave voltage ≥1.22mV,
B, P-wave voltage ≥ 0.2mV, spike-type, combined with P-axis > +80o
C, P wave is low voltage, P voltage>1/2R, spike type, combined with P electrical axis>80o
② Secondary diagnostic criteria.
Limb lead hypovoltage
Right bundle branch conduction block (incomplete or complete)
Combined with the medical history, with one of the above primary conditions can be diagnosed, and two secondary conditions can be listed as a manifestation of suspected pulmonary heart disease ECG.
(4) Diagnostic criteria for echocardiography.
①Main condition.
Right ventricular outflow tract ≥ 30 mm
Right ventricular end-diastolic internal diameter ≥20mm
Right ventricular anterior wall thickness ≥5.0mm, or with amplitude enhancement
Left ventricular to right intraventricular diameter ratio <2 mm< p="">
Right pulmonary artery internal diameter ≥18 mm or main pulmonary artery internal diameter ≥20 mm
Ratio of right ventricular outflow tract to left atrial internal diameter >1.4
Pulmonary valve echocardiography with signs of pulmonary hypertension (“a” wave hypotonic or <2 mm, with mid-systolic closure < p="">)
②Reference conditions.
septal thickness ≥12 mm, amplitude <5 mm, or signs of paradoxical motion< p="">
Right atrium ≥25mm (subxiphoid region probing)
(5) Electrocardiographic vector diagnostic criteria.
On the basis of thoracic and pulmonary disease, electrocardiographic vectors with indications of enlarged right ventricle and right atrium are consistent with the diagnosis.
(6) Radionuclide.
Increased blood flow in the upper part of the lung and decreased blood flow in the lower part of the lung on pulmonary perfusion scan indicates possible right pulmonary hypertension
(7) Arterial blood gas analysis.
Acute exacerbation of pulmonary heart disease is often combined with respiratory failure, PaO2 <60mmhg (8.0kpa), paco2>50mmHg (6.67Kpa). Hypoxemia and hypercapnia are also often present during remission.
(8) Blood tests.
In co-infection, total white blood cells ↑, neutrophils ↑
Common red blood cells and hemoglobin ↑
Whole blood and plasma viscosity ↑
Some patients may have changes in liver and kidney function
Changes in potassium, sodium, chloride and calcium in serum
Combined with the medical history, pulmonary heart disease can be diagnosed according to the above criteria.