5) chronic pulmonary heart disease - etiology , clinical presentation , diagnosis , management

Question 1

what is the cause of for pulmonale ?

Answer 1

increase of pulmonary arterial pressures
endothelia dysfunction and and proliferation
increase after load of right ventricle

Question 2

what is the clinical presentation of chronic pulmonary heart disease ?

Answer 2

fatigue
dyspnea
angina pectoris like thoracic pain
and peripheral edema

Question 3

what is the diagnosis ?

Answer 3

elevated jugular vein
loud 2 heart sound of pulmonic valves
ECG - signs of right heart hypertrophy
right axisl devotion of more than 100 degrees
ratio of r wave amplitude to s wave amplitude is greater than 1 in v1
and less than 1 in v6

echocardiography - hypertrophy of right ventricle

Question 4

what is the management of the disease ?

Answer 4

if pulmonary artery hypertension -

pulmonary artery relaxation -
sildenafil
side effects - blue vision
reflex tachycardia

if there is pulmonary embolism
anticoagulants such as
heparin - given through IV
paradoxical heparin iduced thrombocytopnea , osteoperosis

low molecular heparin - enoxiparen - lower risk of bleeding
but given subcutaneous

warfarin or acenocomural
adverse effects - hepatotoxicity
hemorrhages

selective calcium antagonist- flunarzine

diuretics -spironolactone aldosterone antagonist - hyperkalemia

for congestive heart failure
ACEI - enalapril , lisinoprril
produces dry non productive cough , hyperkalemia
pump more blood to the rest of your heart without working harder