Respiratory insufficiency

Respiratory Failure Disease

As a result of abnormalities in lung structure or function, right ventricular hypertrophy or dilatation is called cor pulmonale. Left heart disease and congenital heart diseases such as heart and lung abnormalities that develop core pulmonale'de. However, these abnormalities are related to complications of heart disease.

Etiology

The main cause of Cor pulmonale in chronic obstructive pulmonary diseases (chronic bronchitis and emphysema), dir. 20% of all heart diseases, cor pulmonale.

Such as chronic bronchitis and emphysema often found together in some cases are associated with asthma. Chronic obstructive pulmonary disease progresses, and some of the facilitating factors, for example, pneumonia is a lung disease such as cor pulmonale turns.

Pulmonary hypertension is the major factor in the occurrence of cor pulmonale and right heart failure. There is an important contribution to the development of pulmonary hypertension and hypoxia. Hypoxemia with chronic obstructive pulmonary disease develops before the exertion. Later, the rest is hypoxemia. Hypercarbia during more advanced disease (increase of C02 in the blood) develops. Hypoxemia, such as increased pulmonary vascular resistance caused by the increase C02'nin vasokonstriksiyon by facilitating the effect of an increase in pulmonary hepertansiyonun more help.

Clinical symptoms

Chronic obstructive pulmonary disease (COPD) patients in cor pulmonale caused by smoking more often içenlerdir years. Cor pulmonale for many years before there are dyspnea and cough. Progress or an infection such as pneumonia, lung function komplikasyonuyla KOAH'mn more disturbed than cor pulmonale and right heart failure and then converted.
On physical examination, dyspnea, syanoz, tachypnea, wheezing and a respiratory (wheezing) are available. Syanoz, cor pulmonale is a common finding. Especially in the cases of bronchiectasis and chronic bronchitis are the fingers, clubbing-encounter. Advanced, patients with respiratory acidosis, decreased consciousness, coma, drowsiness, and may. As observed in the liver in patients with diminished tremor (asterixis), a common finding. Dizorientasyon, headache, speech disorder, small pupil, fast-sıçrayıcı pulse, warm and moist hand and papillary edema, respiratory acidosis other related symptoms.

Heart failure occurred and jugular venous pressure (venous pressure increase) occurs. Respiratory muscles, respiratory support and help, such as the sternocleidomastoid skalenus çabalarıyle dyspnea becomes more specific. Puckered lips of the patient breathes to prevent collapse of the bronchi. Increased thoracic anterior-posterior diameter. Intercostal spaces and ribs enlarged severe respiratory movements decreased. Palpation the left sternal border, right ventricular push monitored. Much air is filled with percussion and diaphragmatic movements in a specific reduction in lung hipersonorite determined. Cor pulmonale in emphysema patients developing liver is pushed down. Hepatemegali karıştırmamalıdır with this. Auscultation hafiflediği breath sounds, prolonged expiratory inspiration and expiration sibilan, ronflan Railer heard.

P2 is exacerbated. Range is increased because of emphysema and pulmonary heart toraks'arasındaki with hardly hear heart sounds. The patient is fixed firm dinlenince voices sounded more certain. In some cases, transient arrhythmias heard.

There is edema of the legs in cases of right heart failure, ECG findings of right ventricular hypertrophy seen.

Radiological findings

Heart is usually enlarged. However, this expansion is not always apparent. Anterior-posterior diameter of the lateral radiograph of the heart can be seen growing. Suspicious cases, the patient's current movie film taken in a comparative old flimleriyle or after treatment. If there is a difference cardiomegaly finalized. Emphysema-than-air appearance of lungs in cases of cor pulmonale (hyperinflation) and are sometimes monitored fibrosis. Itilme diaphragm down, and kubbeleşme flattening occurs.

Lung function tests Lung Function Test

Lung function tests, the cause of cor pulmonale with COPD or other lung disease is a nature and degree of functional impairment would be enlightening. The disease progresses, forced vital capacity, 1 second percentage (ZVK1), diffusing capacity (DA), and arterial blood oxygen tension (PA02) is reduced. A more serious situation occurs when the arterial blood PaC02 increased by respiratory acidosis. Lung function tests and arterial blood gas, especially in the course of the disease and evaluate the success of treatment is very useful.
Laboratory examination

Is most often seen in cases of polycythemia and cor pulmonale. If you have an intercurrent infection increases white blood cell.

ECG Findings: 2 / 3 cases of cor pulmonale have ECG findings of right ventricular hypertrophy. Some of the ECG is normal in cases of cor pulmonale.

Other lung diseases, cor pulmonale

Advanced stages of chronic diseases of the thorax and lung parenkimasının pulmole husule bring core. Widespread fibrosis, scleroderma, pneumococcal-yozlar, diffuse bilateral tuberculosis, cancer metastasis, widespread, kolagen diseases, and lung parenkimasının sarkoidosis other hastalıklarıda cause cor pulmonale. The remaining lung after pneumonectomy and lobectomy emphysema, chronic bronchitis may be caused as a progressive disease develops core pulmonale'ye. Pleural diseases, severe kyphoscoliosis, Pickwick syndrome, neuropathy, myopathies, and vascular diseases of the lung, cor pulmonale may occur, especially thrombo-embolism.

Treatment of Cor pulmonale

If you have the right heart hypertrophy and heart failure, which causes lung disease treatment is applied with. Lack of ventilation for the treatment of infection, bronkospasm, hypoxia should be under control, as well as diuretics and cardiac decompensation should be treated digitalis'le.
Most patients with chronic bronchitis and emphysema, smoking drink. Non-bronchial secretion and increases the resistance of the respiratory tract. Smoking slows down the course and complications of the disease is left is reduced. Purulent sputum, listening to localized or generalized years, dry Railer, leukocytosis, and chest radiography, lung infection in areas of concentration will be indicated. Sputum culture and antibiotic sensitivity of bacteria (antibiotic) to be examined is treated with antibiotics. Bronchodilator drugs better ventilation will help reduce bronkospasmı. Concentration of 25-35% oxygen inhalation for the treatment of hypoxemia than once is enough.
Digital and diuretic drugs in the treatment of right heart failure is an important place. Salt-free diet should be applied.

Hypoxemia and respiratory acidosis uncontrolled patients are treated in intensive care units.

Lung transplantation

In some patients, despite the treatment advances and life-threatening right heart failure. In these patients, lung transplant to save his life and prolong life. Cases of bilateral lung transplantation or heart or lung transplantation than are ünlateral

Prognosis

Cor pulmonale, right heart failure and the development of poor-prognosis leştirir. For example, the mortality rate within 4 years, 50% of cases of cor pulmonale, right heart failure, although it is 75% of cases is growing. The important thing is to take measures to delay or prevent right heart failure. Once it starts, right-heart failure than the others, followed by shorter periods of time. Oxygen therapy in hypoxemic patients with pulmonary hypertension will decrease. Therefore, ambulatory oxygen therapy is needed portable gadgets. Decrease of right heart failure in patients with this treatment is applied to obtain a better prognosis.