And home management of pulmonary heart disease.
(1) Health care guidance for patients with cor pulmonale, referred to as "cor pulmonale", is one of the common heart diseases in middle-aged and elderly people. The following points are for self-care reference of patients with cor pulmonale:
1. If you have a cold, you should put on clothes in time, don't catch cold, don't let yourself feel cold, and pay more attention to wearing warm clothes when you go out. Once caught cold, the blood vessels of bronchial mucosa contract, and the immune function of patients with cor pulmonale is low, which is easy to cause virus and bacterial infection. Generally, the upper respiratory tract first, and then spread to the lower respiratory tract, causing pneumonia or bronchopneumonia. In addition, for patients with cor pulmonale, keeping feet warm is also very important and can not be ignored.
2. Take part in outdoor activities. When the weather is fine, you can go for a walk in parks, forests and other places with fresh air, and do some exercises you can, such as playing Tai Ji Chuan, Qigong, abdominal breathing exercises, etc., to exercise the diaphragm function and persevere. When sweating, dry it with a dry towel and change your underwear in time. The results show that long-term exercise can improve immune function and lung function. The amount of exercise is based on the premise of not causing shortness of breath or other discomfort. Avoid going to places with dirty air.
3. Keep indoor air circulation. You should open the window in the morning to get some fresh air. Burning charcoal fire or coal fire in the bedroom, especially without exhaust pipe, is not good for patients with cor pulmonale and should be avoided as much as possible.
4. Life should be regular. What time do you get up, sleep, eat, defecate and go out for a walk every day? You'd better take a nap at noon. Feel comfortable and family members should live in harmony. Patients with cor pulmonale are inevitably angry because of long-term suffering from the disease, so try to restrain yourself and not lose your temper.
Smokers should give up smoking completely, and don't even talk to smokers, play chess or cards, because passive smoking is equally harmful to patients with cor pulmonale. Expectoration in time to keep the respiratory tract clean.
6. To supplement nutrition. Patients with cor pulmonale often have nutritional disorders, and there are more emaciated people, but they often have poor appetite. In principle, you should eat less and eat more meals, and you can also take some drugs to strengthen your stomach or help digestion. It is not advisable to eat too salty food.
7. The manifestations of pulmonary heart disease complicated with lower respiratory tract infection are often atypical, and symptoms such as fever and cough may not be obvious, sometimes only manifested as shortness of breath, increased sputum volume or thickened sputum. All these should go to the hospital in time, don't delay.
8. Don't abuse cardiotonic, diuretic and propranolol by yourself. Improper medication will aggravate the condition and even cause accidents.
9. Family oxygen therapy can be carried out if conditions permit, which is conducive to improving hypoxia, improving quality of life and prolonging life.
10. In order to improve the immune function of the body, before the arrival of a bad cold, BCG injection can be injected intramuscularly, once 1ml, twice a week, for a total of ***3 months. This can reduce the occurrence of colds and upper respiratory tract infections.
(2) Family management of cor pulmonale
Pulmonary heart disease, referred to as cor pulmonale for short, refers to a heart disease that causes pulmonary hypertension and centripetal hypertrophy due to pathological changes of lung tissue, chest or pulmonary artery, and eventually develops into right heart failure. Clinically, it can be divided into acute pulmonary heart disease and chronic pulmonary heart disease, of which chronic pulmonary heart disease is the most common.
First, acute pulmonary heart disease (acute pulmonary heart disease)
[etiology]
Mainly caused by severe pulmonary embolism. The most common cause is peripheral vein or pelvic vein thrombosis, followed by right heart thrombosis, cancer embolism, air embolism and fat embolism.
[Clinical manifestations]
Sudden paroxysmal dyspnea, cyanosis, severe cough, palpitation, hemoptysis, chest pain, retrosternal pain, etc. They are all accompanied by a sharp drop in blood pressure, pale skin, sweating, cold limbs and even sudden death due to shock, heart failure, cardiac arrest or ventricular fibrillation.
[Diagnostic Points]
(1) has a history of primary pulmonary embolism.
(2) Sudden dyspnea, cyanosis, cough, hemoptysis, chest pain and other clinical manifestations.
(3) Physical examination showed that the cardiac boundary was widened, the second heart sound in the pulmonary valve area was hyperactive with murmur, and systolic murmur and galloping rhythm could also be heard in the tricuspid valve area; When the right heart fails, jugular vein dilatation, hepatomegaly, pain and tenderness may occur.
(4) ECG can have obvious right deviation of the electric axis, clockwise rotation and right bundle branch block; S wave in leads I and avL deepened, ST segment in leads II, III, avL and avF decreased, and T wave in leads of right ventricle was inverted.
(5) At the early stage of X-ray examination, the costal diaphragm angle can be blurred and the vascular shadow of the diseased hilum can be deepened; In severe cases, the pulmonary artery segment may be thickened and prominent, and the cardiac shadow may be enlarged.
[Differential diagnosis]
(1) acute myocardial infarction
There is squeezing or choking pain behind the sternum, which radiates to the left shoulder and left arm. Except pulmonary edema, there is generally no hemoptysis, and ECG has the characteristic changes of myocardial infarction.
(2) Spontaneous pneumothorax
There is sudden chest pain and dyspnea, similar to pulmonary embolism, but the affected side of pneumothorax swells, the breathing sound disappears and the trachea deviates to the healthy side. X-ray examination can show the changes of pneumothorax, which is helpful for diagnosis.
(3) aortic dissection aneurysm
Sudden severe chest pain, dyspnea and shock may occur, which is similar to pulmonary embolism, but most patients with dissecting aneurysm have hypertension, arteriosclerosis and elevated blood pressure in both upper limbs. X-ray examination and echocardiography are helpful for diagnosis.
[family emergency treatment]
(1) Stay in bed, take a semi-recumbent position or an upright position, and lower limbs droop.
(2) Give a diet with high calorie, multivitamins and digestible food.
(3) When fidgety, you can take diazepam 10 mg 1 time for sedation.
(4) Patients with shock should lie on their back with their heads slightly lower, keep warm and keep the respiratory tract unobstructed.
(5) After the above-mentioned emergency treatment, send it to the hospital for emergency treatment.
Second, chronic pulmonary heart disease.
[etiology]
(1) lung and bronchial diseases: tracheitis target = _ blank >；; The most common diseases are chronic bronchitis and obstructive emphysema, followed by severe tuberculosis, bronchiectasis, bronchial asthma, lung abscess and silicosis.
(2) Chest diseases: such as spinal tuberculosis, rheumatoid spondylitis, thoracic surgery, etc.
(3) Pulmonary vascular diseases: such as pulmonary inflammation and primary pulmonary hypertension.
[Clinical manifestations]
During the compensatory period of pulmonary and cardiac function, there are mainly chronic cough and expectoration, palpitation, shortness of breath, fatigue and cyanosis during mild activity.
When the pulmonary heart function is decompensated, that is, acute attack, the clinical manifestations of acute cor pulmonale are respiratory failure and heart failure.
[Diagnostic Points]
(1) has a history of chronic primary lung disease, and most of them are over 40 years old.
(2) Clinical manifestations of pulmonary and cardiac functions in compensatory and decompensated periods.
(3) Physical examination may include emphysema sign, hyperactivity of second heart sound in pulmonary valve, systolic murmur and galloping rhythm in tricuspid valve area, jugular vein dilatation, hepatomegaly, positive hepatojugular vein reflux sign, ascites and edema of lower limbs.
(4)X-ray examination may have emphysema changes.
(5) ECG may have low voltage, clockwise rotation, right deviation of electric axis, pulmonary P wave, right ventricular hypertrophy and right bundle branch block.
(6) Echocardiography showed changes of pulmonary hypertension.
(7) Pulmonary function examination, blood gas analysis and pH measurement are all helpful for diagnosis.
[Differential diagnosis]
(1) coronary heart disease
There may be a history of cardiac colic or myocardial infarction, and physical examination, X-ray and electrocardiogram examination are mainly left ventricular hypertrophy.
(2) Rheumatic valvular disease
There is often a history of rheumatism, organic murmur in mitral valve area, X-ray examination or right ventricular hypertrophy, electrocardiogram and echocardiography are helpful for differentiation.
(3) Congenital heart disease
The onset age is young, and cyanosis and heart failure symptoms appear. X-ray examination can enhance the pulse of hilar blood vessels, and cardiovascular examination is helpful for differentiation.
[family emergency treatment]
(1) In the recovery period, it is necessary to improve the body's disease resistance, improve lung function and prevent colds.
(2) The following measures should be taken during acute attack:
① Control of respiratory tract infection: SMZ CO 2 tablets twice a day and TMP 0.2 twice a day can be selected.
② Improving lung function: expectorant and antiasthmatic drugs can be used. Generally, Shuangtang 8 ~ 16 mg, three times a day, aminophylline 0. 1 ~ 0.2 g, or salbutamol 2 ~ 4 mg, three times a day can be taken orally.
③ Control of heart failure: diuretics are not needed when edema is mild; Patients with moderate edema can take hydrochlorothiazide 25 mg, 1 ~ 3g, 1 time daily, or take methotrexate 50 ~ 100 mg,1~ 3g,1time daily; Severe edema can be sent to hospital for treatment.