pneumoconiosis



OVERVIEW

Definition.

Pulmonary heart disease, referred to as cor pulmonale, is a serious disease of the respiratory and circulatory systems.

Pulmonary heart disease is a condition characterized by right ventricular hypertrophy, with or without right heart failure, caused by increased pulmonary vascular resistance and pulmonary hypertension due to bronchopulmonary tissue, thoracic, or pulmonary vascular pathology.

Classification

Acute pulmonary heart disease: common in acute pulmonary embolism. The onset of the disease is rapid, and in severe cases, respiratory failure and/or heart failure may occur, even endangering life and health.

Chronic Pulmonary Heart Disease: More common than acute pulmonary heart disease. Chronic pulmonary heart disease progresses slowly, in addition to the signs and symptoms of the original disease, signs of respiratory failure, heart failure and other organ damage gradually appear.

Morbidity

Incidence rate

According to China’s data in the 1970s, the incidence rate of pulmonary heart disease (chronic) among people over 14 years of age in China was 4.8 per thousand.

The results of a study conducted in 1992 in rural areas of some provinces and cities showed that the overall incidence rate of the surveyed population was 4.4 per thousand, and the incidence rate of the population over 15 years of age was 6.7 per thousand.

Gender distribution

Men and women are equally likely to suffer from pulmonary heart disease, and there is no significant gender difference.

Age distribution

The incidence of chronic pulmonary heart disease increases with age.

Geographic Distribution

People living in cold regions are more likely to develop chronic pulmonary heart disease.

Economically disadvantaged areas have a higher prevalence compared to economically developed areas.

Causes

Causes

Acute pulmonary heart disease

Pulmonary embolism.

Acute respiratory distress syndrome.

Chronic pulmonary heart disease

The occurrence of chronic pulmonary heart disease is mainly related to the lesions of bronchial-lung tissues, thorax, and pulmonary blood vessels.

Lesions of the bronchial tubes and lung tissues can both cause increased pulmonary vascular pressure, pulmonary hypertension, and ultimately chronic pulmonary heart disease.

Chronic obstructive pulmonary disease, including chronic bronchitis and obstructive emphysema, is one of the most important causes of the disease.

Bronchial asthma.

Bronchiectasis.

Tuberculosis.

Pneumoconiosis (pneumoconiosis).

Idiopathic diffuse interstitial fibrosis.

Diffuse panfine bronchitis.

Nodular disease.

Restriction of thoracic motion can lead to lung compression, bronchial twisting and deformation, pulmonary vasoconstriction, and elevated pulmonary artery pressure, ultimately causing chronic pulmonary heart disease.

Extensive pleural adhesions.

Rheumatoid spondylitis.

Thoracic and spinal deformity diseases.

Pulmonary vascular lesions can lead to elevated pulmonary artery pressure and increased right ventricular loading, gradually leading to chronic pulmonary heart disease.

Pulmonary embolism.

Pulmonary vasculitis.

Primary pulmonary hypertension.

Neuromuscular disorders and ventilation drive disorders can reduce respiratory activity and insufficient alveolar ventilation, causing pulmonary vasoconstriction, leading to pulmonary hypertension and the development of chronic pulmonary heart disease.

Common neuromuscular diseases: myasthenia gravis, acute inflammatory demyelinating polyneuropathy, and poliomyelitis.

Common ventilation drive disorder: obesity-hypoventilation syndrome, sleep apnea syndrome, etc.

Pathogenesis

Mechanisms of pulmonary hypertension formation

Pulmonary vascular remodeling: one of the most important causes of hypoxic pulmonary hypertension. Chronic inflammation of the bronchial tubes and their surrounding lung tissues often involves the small pulmonary arteries, causing inflammation of the small pulmonary arteries, pulmonary vascular wall thickening with spasm, collagen fibers and elastic fibers increase in the pulmonary vasculature, resulting in pulmonary artery vascular stiffness, luminal narrowing or occlusion, and the pulmonary arterial resistance is greatly increased.

Pulmonary capillary compression: long-term chronic obstructive pulmonary disease can lead to increased alveolar air content, increased pressure within the alveoli, can compress the pulmonary capillaries, so that the lumen of the blood vessels is narrowed or occluded, further leading to high pressure in the pulmonary circulation.

Pulmonary artery thrombosis: acute and chronic pulmonary embolism can appear pulmonary artery micro thrombus, can lead to pulmonary vascular resistance enhancement, leading to pulmonary hypertension.

Pulmonary vasospasm: hypoxia, hypercapnia and respiratory acidosis can cause pulmonary vasoconstriction and spasm through neurohumoral mechanisms, leading to increased resistance of the pulmonary circulation and further leading to pulmonary hypertension.

Mechanism of cardiac injury

Long-term pulmonary hypertension causes an increase in right ventricular afterload, leading to an increase in right ventricular wall tension, thickening of the ventricular wall, and an increase in ventricular volume.

The increased ventricular volume can affect the conduction system of the ventricle, which in turn induces arrhythmias.

Increased right ventricular wall tension leads to increased coronary resistance, decreased right ventricular myocardial blood flow, and decreased myocardial oxygen supply.

Hypoxemia and bacterial toxins in recurrent respiratory infections can produce direct damage to the myocardium. In turn, myocardial contractility is weakened and cardiac pumping dysfunction occurs.

This can be compensated by various mechanisms in the early stages, and later with limited left ventricular emptying and reduced ejection fraction.

Enlargement of the ventricular volume can lead to tricuspid valve insufficiency, further aggravating heart failure.

Symptoms

Main Symptoms

Symptoms of acute pulmonary heart disease

The onset of the disease is rapid.

Difficulty in breathing, which may be accompanied by a sense of suffocation in severe cases.

Chest pain.

Irritability, which may be accompanied by emotional and mental disturbances.

Cyanosis, i.e. purple coloration of the skin and mucous membranes.

Syncope, sudden, brief and complete loss of consciousness, lasting a few seconds to a few minutes, mostly caused by various reasons of transient insufficient blood supply or oxygen supply to the brain, generally faster recovery.

In severe cases, sudden death, i.e., unanticipated death occurring within a short period of time, may also occur.

Symptoms of chronic pulmonary heart disease

Chronic pulmonary heart disease is categorized according to the progress of the disease into the compensatory stage of pulmonary and cardiac function and the compensatory stage of pulmonary and cardiac function.

In the compensated stage, symptoms of respiratory disease are predominant, most commonly associated with chronic obstructive pulmonary disease (COPD), including cough, sputum, shortness of breath, dyspnea, palpitations, fatigue, and decreased labor endurance.

Symptoms in the decompensated phase are dominated by respiratory failure and, in severe cases, right heart failure.

Respiratory failure is mainly a symptom caused by hypoxia and carbon dioxide retention, which is manifested by worsening dyspnea, chest tightness, palpitation, shortness of breath, fatigue, cyanosis, excessive sweating, and even headache, irritability, apathy, drowsiness and coma.

Right heart failure is mainly a symptom of stagnant blood in the body circulation, and the following manifestations may occur.

Symptoms of total heart failure

When pulmonary heart disease progresses to the terminal stage, total heart failure occurs, i.e., left heart failure develops on top of right heart failure.

Symptoms associated with decreased blood output in left heart failure, such as fatigue and weakness and decreased activity tolerance.

Symptoms of peripheral stasis, such as jugular venous rage.

Complications

Pulmonary encephalopathy: Early symptoms include headache, dizziness and memory loss. With the progression of the disease there will also be impaired consciousness, drowsiness, lethargy, coma. It may also be accompanied by agitation, increased speech, hallucinations, delusions and other psychiatric symptoms.

Arrhythmia

Disorders of the internal environment: mainly manifested as respiratory acidosis and electrolyte disorders. Respiratory acidosis is often characterized by dyspnea and cyanosis.

Disseminated intravascular coagulation: mainly manifested as bleeding, oliguria and anuria, convulsions and coma and other symptoms.

Venous thromboembolism: manifested by dyspnea, chest pain, pallor, fever and cough.

Consultation

Department of Medicine

Cardiovascular Medicine

Symptoms such as coughing, coughing up sputum, shortness of breath, dyspnea, fatigue and decreased labor endurance, palpitations, dizziness, etc., it is recommended to go to the Department of Cardiovascular Medicine for timely consultation.

Emergency Department

Sudden severe chest pain, dyspnea, and impaired consciousness, etc., it is recommended to go to the Emergency Department immediately.

Preparation for medical treatment

Consultation: registration, preparation of information, common problems

Consultation Tips

Patients with pulmonary heart disease often have a history of respiratory tract infections, and should consult a doctor promptly if they develop palpitations and dizziness after respiratory tract infections.

Do not abuse drugs without the doctor’s permission, so as to prevent drugs from affecting the relevant examinations and interfering with the diagnosis and treatment of the disease.

Preparation checklist for medical consultation

Pay special attention to the time of onset of symptoms, special manifestations, etc.

Are there symptoms of fatigue, loss of appetite, palpitations, dizziness, dyspnea?

Have you recently experienced edema of the lower limbs or the whole body?

Are these symptoms aggravated by exercise or exertion?

How many times a day do these symptoms occur? How long do they last?

Is there any family history of related diseases?

Are there any drug or food allergies?

Do you have chronic obstructive pulmonary disease (COPD) or pulmonary hypertension?

Are you bedridden? Has there been recent surgery?

Are there any other medical conditions?

Test results in the last six months, which can be brought to the doctor’s office

Blood test

Blood biochemistry

Arterial Blood Gases

Echocardiogram

Chest X-ray

CT Pulmonary Arteriography

Right Heart Catheterization

Electrocardiogram

Medication use in the last 3 months, bring medication box or package with you to the doctor if available

Positive inotropic drugs: digitalis, digoxin

Sedative drugs: Isoprinosine

Diuretics: hydrochlorothiazide, spironolactone

Anticoagulants: warfarin

Diagnosis

Diagnostic basis

Acute pulmonary heart disease

Relevant medical history, characteristic clinical manifestations (symptoms and signs), laboratory, electrocardiographic, echocardiographic and imaging findings are important in the diagnosis of acute pulmonary heart disease.

History of lower extremity venous thrombosis, history of trauma, history of labor and delivery, and heart valve disease associated with pulmonary embolism.

History of acute respiratory distress syndrome.

Symptoms: rapid onset of dyspnea, pain in the anterior chest region, irritability, clammy skin, impaired consciousness and even syncope.

Signs: Acute pulmonary heart disease may present with the following signs.

Routine blood test: Acute pulmonary heart disease may show accelerated erythrocyte sedimentation rate, as well as increased white blood cell count.

Blood biochemistry: Acute pulmonary heart disease may show significant elevation of D-dimer, mild elevation of lactate dehydrogenase, creatine kinase and creatine kinase isoenzyme, and electrolyte abnormalities.

Arterial blood gas analysis: Patients with acute pulmonary embolism have reduced arterial oxygen levels and normal or elevated partial pressures of carbon dioxide.

An electrocardiogram can help to exclude acute myocardial infarction and can provide a rapid identification of certain patients with severe pulmonary heart disease.

Transthoracic echocardiography can identify signs of pulmonary artery widening, right heart enlargement, and decreased right heart contractility.

Transesophageal echocardiography can identify thromboemboli in the pulmonary arteries and right ventricle.

CT pulmonary arteriography (CTPA), radionuclide pulmonary ventilation/perfusion (V/Q) imaging, and pulmonary arteriography are important in the diagnosis of pulmonary embolism and acute pulmonary heart disease, but they are usually used when the condition is relatively stable and the diagnosis is difficult because of the critical nature of the disease.

CT pulmonary arteriography (CTPA)

Radionuclide pulmonary ventilation/perfusion (V/Q) imaging

Pulmonary arteriography

Chest X-ray

Ultrasound of the deep veins of the lower extremities: ultrasound can detect blood clots in the deep veins of the lower extremities, which can be an important indication of pulmonary embolism.

Chronic Pulmonary Heart Disease

Early diagnosis of chronic pulmonary heart disease is relatively difficult.

In individuals with a history of bronchopulmonary tissue, as well as thoracic disease, the diagnosis of chronic pulmonogenic heart disease can be made as soon as pulmonary hypertension develops, with or without enlargement of the right ventricle.

History of chronic obstructive pulmonary disease.

History of interstitial lung disease.

History of sleep apnea syndrome.

History of asthma.

History of tuberculosis.

History of pneumoconiosis.

History of thoracic deformities such as posterior thoracic kyphosis.

Symptoms: Weakness, cough, dyspnea, cyanosis (bruising of the skin), palpitations, chest tightness, decreased activity tolerance, loss of appetite, and lower extremity and/or generalized edema.

Signs: the following signs may be present in chronic pulmonary heart disease.

Arterial blood gas analysis: Blood gas analysis can determine the presence of hypoxia and carbon dioxide retention, as well as the presence of respiratory failure through the partial pressure of oxygen and carbon dioxide. It can assist in determining the condition and diagnosis of the cause of the disease. A follow-up oxygen therapy program can also be developed.

Blood routine examination: chronic pulmonary heart disease can be manifested as accelerated erythrocyte sedimentation rate and increased red blood cell count.

Special blood substance test: brain natriuretic peptide and/or N-terminal brain natriuretic peptide test can help the doctor diagnose whether there is right heart dysfunction.

Blood biochemistry test: it can help the doctor to determine whether electrolyte is disordered, whether liver and kidney functions are normal, etc. Although these are not directly helpful in diagnosing pulmonary heart disease, they can determine whether heart failure is present.

The electrocardiogram of chronic pulmonary heart disease can show the right deviation of the electrical axis, ST segment and T wave changes.

The ECG can also be used for differential diagnosis of other cardiac diseases that cause similar symptoms.

Echocardiography is the noninvasive test of choice to assess right heart function.

Echocardiography in chronic pulmonary heart disease shows enlargement of the right ventricle and right atrium.

Chest X-ray: It can be valuable for the diagnosis of the presence or absence of underlying lung and chest diseases and acute lung infections, as well as the presence or absence of pulmonary hypertension.

Cardiac Magnetic Resonance Imaging (MRI): It shows a clear image of the right ventricle to see if there are any changes in the structure of the right heart.

Right heart catheterization can directly measure the pulmonary artery pressure to know whether there is pulmonary hypertension.

It is suitable for people with obvious symptoms of right heart failure and for preoperative examination.

Differential Diagnosis

Primary cardiomyopathy (predominantly dilated cardiomyopathy)

Similarities: both may present with increased heart size.

Differences: Dilated cardiomyopathy usually does not have a history of respiratory disease, nor does it have pulmonary hypertension and related examination abnormalities. It can be differentiated by a detailed history, chest X-ray, and echocardiography.

Rheumatic heart disease

Similarities: Rheumatic heart disease mainly involves the mitral valve, aortic valve and tricuspid valve, and scar tissue can be formed in the long term, leading to changes such as valve closure insufficiency, which is similar to that of pulmonary heart disease, and also leads to right heart failure.

Differences: Rheumatic heart disease is more common in adolescents and females, and is often associated with sore throat and joint pain before the onset of the disease. In addition, the valves of rheumatic heart disease can be seen to be damaged, whereas pulmonary heart disease is only due to the relative closure insufficiency of the valves due to the enlargement of the heart size, and there is no associated damage. This can be differentiated by history taking, laboratory tests, and echocardiography.

Coronary Atherosclerotic Heart Disease

Similarities: symptoms such as decreased activity tolerance, chest tightness, dizziness, blackouts, or even syncope and dyspnea may occur.

Differences: Coronary atherosclerotic heart disease (CHD) is usually accompanied by a history of chronic diseases, such as diabetes mellitus, dyslipidemia, and hypertension; significant differences in electrocardiogram (ECG) performance; and abnormalities of coronary arteries in CHD. It can be differentiated by history taking, electrocardiogram and coronary angiography.

Treatment

Currently, the treatment of pulmonary heart disease is mainly based on the degree of progression of the disease.

The principle is to actively treat the primary disease and improve the right heart function.

It should be noted that all drugs should be used in accordance with the doctor’s instructions, and should not be adjusted or discontinued on their own.

Treatment of Acute Pulmonary Heart Disease

General treatment

Absolute bed rest, avoid physical activity.

Administer oxygen as prescribed by the doctor and monitor the vital signs.

Eat more food rich in water-soluble dietary fiber and keep bowel movement smooth.

Medication

Apply drugs such as promethazine, which can effectively relieve anxiety and panic symptoms.

Dopamine, dobutamine and levosimendan are commonly used to help enhance myocardial contractility, increase cardiac blood output and relieve symptoms related to heart failure.

Dopamine and norepinephrine are commonly used to help maintain stable blood pressure.

Heparin and warfarin are commonly used to help avoid thrombosis and improve overall prognosis.

Newer oral anticoagulants, including the direct thrombin inhibitor dabigatran and the factor Xa inhibitor rivaroxaban, have advantages over warfarin, such as a low risk of bleeding and no need for routine monitoring, and can be used for anticoagulation in patients at high risk of bleeding from pulmonary embolism.

Thrombolytic drugs are available for thrombolytic therapy in patients with early massive pulmonary embolism.

Thrombolytic drugs include urokinase, streptokinase and recombinant tissue-type plasminogen activator (rt-PA). These drugs can be injected directly into the pulmonary artery through a catheter, which may improve the efficacy of the treatment.

Surgery

Surgical treatment can effectively improve the symptoms of embolism and relieve the condition.

Commonly used surgical methods include embolization and placement of inferior vena cava filters.

Embolization is only suitable for the more critical patients with massive pulmonary embolism, as well as those who are not suitable for intravenous thrombolytic therapy or those who have poor therapeutic effects.

Placement of an inferior vena cava filter is indicated in patients with contraindications to anticoagulation and for the prevention of recurrent pulmonary embolism, but is not suitable for the treatment of acute pulmonary embolism.

Interventional therapy

Currently, cardiac catheters are mostly used to aspirate or crush the emboli, which can effectively relieve the symptoms of embolism and control the progression of the disease.

Interventional therapy is prohibited for those with unclosed foramen ovale.

Treatment of chronic pulmonary heart disease

Chronic pulmonary heart disease is categorized into compensated and decompensated phases of cardiopulmonary function, with different treatment methods. In the compensated stage, treatment of chronic lung disease is the mainstay. The decompensated stage focuses on controlling infections and correcting cardiac and pulmonary failure.

Treatment of compensated cardiopulmonary failure

Restriction of salt and water intake, the exact amount of restriction should be judged by the doctor according to the condition.

Oxygen therapy, through the inhalation of oxygen to increase the partial pressure of blood oxygen, to improve the symptoms of hypoxia.

Monitor the vital signs and seek medical advice if there is any abnormality.

Prevent infection and strengthen body resistance, such as persistent exercise and balanced nutrition.

Vaccination against influenza or pneumonia can be done annually.

Treatment of cardiopulmonary failure

Positive inotropic drugs

Diuretics

Calcium channel blockers

Statins

Surgery

Lung transplantation: for patients with chronic pulmonary heart disease who have failed other treatments.

Lung decompression: bronchoscopic lung decompression therapy is mainly indicated for patients with end-stage chronic pulmonary heart disease, and can also be used as a transitional treatment for waiting for a lung source before lung transplantation.

Prognosis

Cure

Acute Pulmonary Heart Disease: When the cause is removed, there is a possibility of recovery of cardiac function and therefore of cure.

Chronic Pulmonary Heart Disease: It is irreversible and cannot be cured, but with active treatment the patient’s quality of life can be improved.

Harmful

Impact on normal life

At the beginning of pulmonary heart disease, symptoms such as dyspnea, cough and weakness may appear, followed by loss of appetite, abdominal distension and edema, which will make people feel uncomfortable and seriously affect their normal work, study and life.

Causes complications

Chronic Pulmonary Heart Disease can cause complications such as respiratory failure, heart failure, arrhythmia, pulmonary encephalopathy, diffuse intravascular coagulation, etc., which seriously affects physical and mental health.

Life-threatening

Acute pulmonary heart disease often has a rapid onset, and in severe cases, respiratory failure and/or heart failure may occur, which may even be life-threatening.

Chronic Pulmonary Heart Disease is often associated with heart failure during respiratory infections, which can also be life-threatening if not treated promptly.

Daily

Daily Management

Dietary management

Eat small and frequent meals, and each meal should not be too full.

The principle of diet is light and easy to digest. You can eat more green vegetables and fresh fruits to prevent constipation; at the same time, consume sufficient amount of high quality protein.

To reduce salt intake, the daily salt intake should be below 3 grams, while the normal population is 6 grams. It is also important to pay attention to hidden salt, such as salt in pickled and processed foods.

Avoid drinks such as coffee and strong tea.

Food and water should be clean to prevent intestinal infections.

Life management

Strictly quit smoking.

Ensure adequate sleep.

Avoid excessive stress and relax.

Pay attention to increase or decrease clothing according to the season to prevent upper respiratory tract infectious diseases.

Exercise appropriately to enhance physical fitness as long as cardiac function permits. Consult your doctor for specific exercise programs.

Family support

Learn to take oxygen at home and follow the doctor’s instructions for proper oxygen therapy.

Learn to use inhaled medication.

Psychological support

Positively adjust the bad mood and keep a good mindset.

Disease monitoring

Monitor blood pressure and heart rate, and seek medical advice when there are more obvious fluctuations.

Record the amount of water in and out every day, i.e. the amount of water intake and the amount of urination, etc. every day.

Measure your weight daily and record it in a book.

Follow-up and review

Follow the doctor’s instructions for regular checkups so that the doctor can understand your condition and adjust the treatment plan.

You should bring along your medical records, laboratory tests, imaging reports, etc., as well as the record book for self-monitoring when you have a follow-up visit.

If you experience fatigue, decreased activity tolerance, loss of appetite, palpitations, dizziness, shortness of breath, or edema, it is recommended that you consult your doctor promptly.

Prevention

Actively treat primary diseases such as chronic bronchitis, thoracic and pulmonary vascular lesions.

Prevent infection, avoid going to crowded places during the period of high incidence of viral infection, or go to the hospital for vaccination, and go to the hospital in time for treatment of colds.

Quit smoking and also avoid second-hand smoke.

If there is occupational exposure, such as long-term, repeated inhalation of some kind of not easily dissolved or irritating dust, need to do a good job of occupational protection, and regular physical examination.

Avoid anxiety and major mood swings.

Exercise reasonably to improve immunity.

Regular work and rest, do not stay up late and get enough sleep.