Generality
The pulmonary heart is a heart disease, which occurs due to a dysfunction of the lungs (or arteries that connect the heart to the lungs) and which causes an alteration of the anatomical structure of the right ventricle. The muscular wall of the latter, in fact, extends (therefore the ventricular cavity widens) and / or thickens (right ventricular hypertrophy), compromising the pumping action of deoxygenated blood towards the lungs.
The cause of the pulmonary heart is pulmonary hypertension, or high pressure in the pulmonary arteries.
The typical symptoms and signs of the pulmonary heart are: dyspnoea, chest pain, cyanosis and leg edema.
The diagnosis must also focus on the causes of the pulmonary heart, as their identification allows for better therapy planning.
A brief reference to the anatomy of the heart
Before describing the disease, it is useful to retrace some fundamental characteristics of the heart.
With the help of the image, readers are reminded that:
- The heart is divided into two halves, right and left. The right heart is composed of the right atrium and the right ventricle below. The left heart is composed of the left atrium and the left ventricle below. Each atrium is connected to the underlying ventricle by means of a valve .
- The right atrium receives non-oxygenated blood through the cavities .
- The right ventricle pumps blood into the pulmonary arteries, which lead to the lungs. In the lungs, the blood is charged with oxygen.
- The left atrium receives oxygenated blood, returning from the lungs, through the pulmonary veins .
- The left ventricle pumps oxygenated blood to the organs and tissues of the human body, through the aorta .
- Each ventricle communicates with its efferent vessel by means of a valve. Therefore, there are four heart valves in all.
What is the pulmonary heart?
The pulmonary heart is a very serious heart disease, which occurs due to a dysfunction of the lungs or pulmonary arteries, characterized by an enlargement of the right ventricular cavity and / or a thickening of the myocardium which constitutes the right ventricle ( right ventricular hypertrophy ) .
In other words, the pulmonary heart can be defined as an anatomical alteration of the right ventricle, due to a persistent problem in the lungs or arteries that lead the blood to oxygenate itself in the lungs.
Myocardium and meaning of right ventricular hypertrophy
The myocardium is the heart muscle. Therefore, the right ventricular hypertrophy that characterizes the pulmonary heart is a form of muscular hypertrophy .
Muscle hypertrophy is generally defined as "the increase in muscle volume caused by the increase in volume of the elements that make up the muscle (ie fibers, myofibrils, connective tissue, sarcomeres, contractile proteins, etc.)".
WHAT IS THE MAIN CONSEQUENCE OF THE PULMONARY HEART
Morphological alterations of the heart in response to pulmonary hypertension. From the mbbsdost.com website.
Since, following the pulmonary heart, the oxygenation of the blood at the level of the lungs is insufficient, all the tissues of the body undergo a state of hypoxia (ie lack of oxygen).
ACUTE PULMONARY HEART AND CHRONIC PULMONARY HEART
Physicians distinguish two forms of pulmonary heart: acute pulmonary heart and chronic pulmonary heart .
The acute form is usually characterized by an enlargement of the ventricular cavity, while the chronic form is mainly characterized by a thickening of the myocardium.
Sometimes, however, it can happen that the pulmonary heart is, first, marked by an enlargement of the right ventricle and, then, by its thickening.
WHICH IS WRONG TO SPEAK ABOUT PULMONARY HEART?
Although the structural changes are the same, right ventricular hypertrophy that occurs as a result of a problem in the left department of the heart (for example in the case of a hypertrophic cardiomyopathy or a defect in the aortic valve) is not to be considered as a pulmonary heart.
Causes
The cause of the pulmonary heart is pulmonary hypertension, which is the rise in blood pressure inside the pulmonary arteries and the right cavities of the heart.
PULMONARY HYPERTENSION AND PULMONARY HEART
In general, pulmonary hypertension is established when the walls of the pulmonary arteries undergo an alteration, due to which they shrink and become completely blocked. This has two consequences: on the one hand, the resistance that the blood meets going from the heart to the lungs increases and, on the other hand, the pumping action of the right ventricle is hindered.
Figure: Comparison section between the pulmonary arteries of a healthy subject and the pulmonary arteries of a subject with pulmonary hypertension. From www.cdc.gov
In other words, at the origin of pulmonary hypertension there is almost always a vasoconstriction of the arteries that lead the blood from the heart to the lungs; such vasoconstriction reduces direct blood flow to the lungs and prevents the right ventricle from functioning normally.
The conditions that can lead to the onset of pulmonary hypertension are numerous and consist mainly of:
Causes of pulmonary hypertension that can give acute pulmonary heart | Causes of pulmonary hypertension that can give chronic pulmonary heart |
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Since the pulmonary heart generally derives from pulmonary hypertension, all the causes of the latter are also to be considered as triggers of the pulmonary heart.
Epidemiology
Currently, there is no statistical data showing the exact annual incidence of the pulmonary heart. However, according to doctors and researchers, the acute form would be linked mainly to pulmonary embolism, while the chronic form would have a particular link with chronic obstructive pulmonary disease.
An interesting numeric data
In the United States, pulmonary heart deaths due to pulmonary embolism would be between 20, 000 and 25, 000 per year.
For yet unknown reason, most patients with pulmonary heart disease are female.
Moreover, they are certainly more at risk of developing this condition: the big smokers, those who live in particularly polluted cities, workers in industrial plants where toxic powders and fumes are produced, etc. (in other words, all those who are exposed to harmful agents for the lungs).
Symptoms and Complications
To learn more: Pulmonary Heart Symptoms
At the beginning, the pulmonary heart could be completely asymptomatic (that is, devoid of obvious manifestations) or be characterized by minor and not always perceptible disorders.
In the more advanced stages, on the other hand, the disease is distinguished by a marked and very evident symptomatology.
The main symptoms and signs of the pulmonary heart are:
- Dyspnea (or shortness of breath), both under stress ( dyspnea on exertion ) and at rest ( dyspnea at rest )
- Sense of fatigue even in doing the simplest tasks
- Dizziness
- Sense of fainting and syncope
- Pain or sense of pressure in the chest
- Edema in the legs, hips and sometimes even the abdomen (ascites)
- Increased heart rate (tachycardia)
- Distension of jugular veins (or turgor of jugular veins)
- Puffs and other abnormal cardiac "noises"
- Persistent cough
WHEN TO REFER TO THE DOCTOR?
Experiencing unusual dyspnea during even minimal effort should induce the victim to contact their physician immediately for a thorough analysis of the situation.
In addition, the appearance of chest pain, edema in the legs (or other parts of the body) and cyanosis also deserves further investigation.
COMPLICATIONS
The vasoconstriction of the pulmonary arteries could cause a reflux of the blood present in the right heart in the direction of the venous system (from which it had previously arrived).
The various veins that may be affected by this reflux include the hepatic vein, which is the blood vessel that normally collects the blood that has just oxygenated the liver cells ( hepatocytes ).
The permanence of deoxygenated blood in the hepatic vein (and in the small adjacent hepatic venules) leads to the establishment of the so-called hepatic congestion (or congestion of the liver ).
One of the consequences of hepatic congestion is the condition known as stasis liver .
Diagnosis
The pulmonary heart is difficult to diagnose, basically for two reasons:
- It could be asymptomatic and go unnoticed
or
- The symptoms and signs it can cause are very similar to those of other heart and lung diseases.
In light of this, in order to be able to identify their presence, the doctor is required to submit the patient to various tests and diagnostic tests.
Usually, after a thorough physical examination, they follow:
- Blood tests
- Echocardiogram
- CT scan (or computed tomography)
- Nuclear magnetic resonance
- Right heart catheterization
- Chest X-ray
- Pulmonary perfusion analysis
- Spirometry
- Pulmonary biopsy
The considerable number of diagnostic tests performed serves not only to establish the precise cardiac problem in place, but also to understand the causes. The knowledge of the triggering reasons allows to plan an adequate treatment.
Treatment
Pulmonary heart therapy depends on the causes of pulmonary hypertension.
TREATMENTS FOR PULMONARY HYPERTENSION
The first treatment that doctors use in case of pulmonary hypertension is pharmacological. In fact, a combination of different drugs is usually provided, which are chosen according to the causes triggering the vasoconstriction of the pulmonary arteries.
In other words, the drug combination varies from case to case, based on the characteristics of pulmonary hypertension.
If the medicines provide poor results or the situation is particularly serious, then surgery will become necessary. In particular, the operations that can be used are atrial septostomy, pulmonary embolectomy (in the presence of pulmonary embolism), phlebotomy (in the presence of polycythemia) and heart, lung or both transplants .
Oxygen therapy has excellent effects on some patients (for example, COPD patients). Oxygen therapy consists in administering oxygen and allows the hypoxia state to be resolved, at least in part.
Attention: To know, in detail, all the possible medicines for pulmonary hypertension, the reader is advised to consult the Drugs to treat Hypertension. Here it is recalled only that the pharmacological treatments available today for the treatment of the pulmonary heart do not make it possible to recover from the disease, but are limited only to improving the symptomatology and avoiding a worsening of the situation.
SOME ADVICES
If you suffer from a pulmonary heart, certain rules should be followed, including the most important:
- Stay at rest when the need is felt.
- Practice regular physical activity . Obviously, this activity must be commensurate with the state of health, as exaggerated efforts could be fatal.
- Not smoking
- If you are a woman, avoid becoming pregnant, because pregnancy could make the situation worse. Furthermore, the life of the fetus would also be in danger.
- Adopt a healthy diet and possibly low in salt (low salt diet ).
Prognosis
The pulmonary heart is a hardly curable heart disease, therefore the prognosis is generally negative.
Two factors affect in particular the life expectancy of patients:
- The severity of the triggering causes. The more severe the condition that is at the origin of the pulmonary heart, the worse is the course of the disease.
- The moment when the diagnosis takes place. When the diagnosis is late, treatments for the pulmonary heart could be ineffective.
