1, chronic pulmonary heart disease (referred to as pulmonary heart disease): refers to heart disease caused by chronic bronchitis, emphysema and other chest diseases or cardiovascular lesions, 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 with the apical region, or systolic murmur.
(2) X-ray diagnostic criteria
1, right inferior pulmonary artery dilatation: transverse diameter ≥ 15 mm; or right inferior pulmonary artery transverse diameter to bronchial transverse diameter ratio ≥ 1.07; or by dynamic observation than the original right inferior pulmonary artery widened by more than 2 mm.
2, Moderate projection 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 450C) or vertebral height ≥7mm.
5, right ventricular enlargement (combined with different body position judgment)
(Only those with one of the above 1-5 items can be diagnosed).
(3) Electrocardiographic diagnostic criteria.
①Main condition.
Frontal mean electrical axis ≥ 90o
V1R/S≥1
Severe cis-clockwise transposition (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, 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 <2mm
Right pulmonary artery internal diameter ≥18mm or main pulmonary artery internal diameter ≥20mm
Ratio of right ventricular outflow tract to left atrial internal diameter >1.4
Pulmonary valve echocardiography with signs of pulmonary hypertension (“a” wave is low or <2mm, with mid-systolic closure disease)
②Reference conditions.
septal thickness ≥ 12mm, amplitude <5mm, or signs of paradoxical motion
right atrium ≥ 25mm (subxiphoid region probing)
(5) Electrocardiographic vector diagnostic criteria.
On the basis of pulmonary thoracic disease, electrocardiographic vectors with indications of right ventricular and (or) right atrial enlargement 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 a 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 with PaO2<60mmHg(8.0Kpa),PaCO2>50mmHg(6.67Kpa). Hypoxemia and hypercapnia are also often present during remission.
(8) Blood tests.
In case of 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.