OVERVIEW
Pulmonary congestion (congestion) is an overfilling of the pulmonary capillaries with blood and is caused by left heart failure. It can be divided into overflow (also known as active) congestion and obstructive (also known as passive) congestion. The former is caused by increased blood flow into the lungs and increased or normal outflow, resulting in overfilling of the pulmonary capillaries. The latter is a stasis congestion of the lungs caused by normal or increased blood flow into the lungs and decreased outflow. Pulmonary congestion occurs mainly during the hot and steamy season. On the basis of prolonged pulmonary congestion, the abnormal increase in the volume of blood in the lungs results in leakage of the plasma component of the blood into the alveoli, fine bronchioles and interstitium of the lungs, causing pulmonary edema.
Causes
1. Overflow (active)
Pulmonary congestion is mainly caused by prolonged overcrowding, stuffiness, and inhalation of large amounts of hot air.
2. Obstructive (passive)
Congestion occurs mainly in cardiac disorders with reduced compensatory function, such as myocarditis, cardiac dilatation, and heart failure caused by various toxic diseases. In addition, in pericarditis, a large amount of exudate in the pericardium affects the diastole of the heart, causing obstruction of pulmonary venous return; in gastrointestinal distension, the negative pressure in the chest cavity decreases and the large venous ducts are compressed, and the outflow of blood from the lungs is difficult, all of which can cause stasis pulmonary congestion.
Symptoms
Dyspnea, persistent cough and sputum, together with the symptoms of pre-existing heart disease, the dyspnea can be gradually aggravated, and the patient can not lie down, or even wake up from sleep due to sudden shortness of breath. In addition, there is cyanosis and rapid heartbeat. As the disease progresses, the patient coughs up brown sputum, plasma sputum or blood-colored foamy sputum.
Physical examination shows a respiratory rate 4 to 5 times higher than normal, wet rales at the base of the lungs on both sides on auscultation, protruding eyes, accelerated pulse, enhanced second heart sound on auscultation, and elevated body temperature.
Examination
1. Physical examination
The lungs have increased alveolar sounds on auscultation, drumming sounds on percussion, and frequent pulse. In active congestion, the pulse is strong and heart sounds are enhanced; in passive congestion, the pulse is weak and so are the heart sounds.
2. X-ray examination
The near hilar shadows are enlarged, and there are thickened lung textures in the inner lung fields of both lungs, with the apices and bases of the lungs being clearer. There is increased pulsation of the hilar vessels.
Diagnosis
A history of left heart failure, coughing up blood-colored foamy sputum, dyspnea, and an increase in the shadow of the lung texture near the hilar region on X-ray may help to make the diagnosis.
Treatment
Treatment of left heart failure is the mainstay of symptomatic relief.