How lung disease overloads the heart
The right ventricle is designed to operate in a low pressure system. When lung tissue is destroyed by emphysema, replaced by fibrosis, or vessels become clogged with blood clots, the area of the vascular bed decreases. Additionally, low oxygen content in the alveoli causes a reflex narrowing of the pulmonary arterioles. Pulmonary hypertension occurs. First, the wall of the right ventricle thickens and copes with the load, then the cavity stretches, the tricuspid valve stops closing and the blood stagnates in the veins of the systemic circle.
- Reduction of the vascular bed of the lungs
- Constriction of arterioles due to lack of oxygen
- Increased pressure in the pulmonary artery
- Thickening of the wall of the right ventricle
- Expansion of the cavity and valve insufficiency
- Stagnation of blood in the veins, liver and tissues
Causes and risk factors
The most common cause is chronic obstructive pulmonary disease, which is closely associated with smoking. Contributions include interstitial lung diseases, severe bronchiectasis, consequences of tuberculosis, and chronic thromboembolism of the branches of the pulmonary artery. A separate group of causes are conditions that limit respiratory movements: severe deformities of the chest and spine, neuromuscular diseases, as well as obstructive sleep apnea syndrome and severe obesity, in which oxygen levels drop at night.
- COPD and emphysema
- Interstitial lung diseases and fibrosis
- Consequences of tuberculosis and bronchiectasis
- Chronic thromboembolic pulmonary hypertension
- Obstructive sleep apnea syndrome
- Kyphoscoliosis and neuromuscular diseases
- Smoking as the main controllable factor
Symptoms
For a long time, complaints of the underlying disease predominate: cough, sputum, shortness of breath on exertion. The addition of the pulmonary heart is indicated by signs of stagnation in a large circle. Swelling of the feet and legs appears, which increases in the evening, heaviness and distension in the right hypochondrium due to an enlarged liver, and swelling of the veins in the neck. The skin becomes bluish and fatigue increases. Sometimes there are fainting on exertion and attacks of palpitations. With an exacerbation of lung disease, all manifestations sharply intensify.
- Increased shortness of breath, including at rest
- Swelling of the legs, increasing in the evening
- Heaviness and pain in the right hypochondrium
- Swelling of the neck veins
- Blueness of lips and fingers
- Thickening of the terminal phalanges of the fingers
- Weakness and decreased exercise tolerance
Diagnostics
The doctor evaluates respiratory function and heart condition at the same time. Spirometry shows the type and severity of ventilation impairment, pulse oximetry and blood gas analysis show the degree of oxygen deficiency. Echocardiography remains the main available method: it allows you to indirectly assess the pressure in the pulmonary artery, see thickening and dilatation of the right ventricle, and tricuspid valve insufficiency. X-ray and CT scan of the chest clarify the cause. Accurate pressure measurement is only possible with right heart catheterization in a specialized center.
- Spirometry and assessment of respiratory function
- Pulse oximetry, blood gases if necessary
- EchoCG with assessment of the right departments
- ECG: signs of overload of the right atrium and ventricle
- X-ray and CT scan of the chest
- NT-proBNP
- Polysomnography for suspected sleep apnea
Treatment and prevention
The main direction is the most effective treatment of lung disease and elimination of oxygen deficiency. If there is a persistent decrease in blood oxygen saturation, long-term oxygen therapy is prescribed for many hours a day: this is the only method with a proven effect on survival in COPD. For edema, diuretics are used under the supervision of a physician, since excessive dehydration impairs the filling of the right ventricle. Smoking cessation, vaccination against influenza and pneumococcus, respiratory rehabilitation and treatment of sleep apnea with a continuous positive pressure device are mandatory.
- Basic therapy for COPD or other lung disease
- Long-term oxygen therapy as indicated
- Diuretics under medical supervision
- Complete smoking cessation
- Vaccination against influenza and pneumococcal infection
- Pulmonary rehabilitation and breathing exercises
- CPAP therapy for sleep apnea
