Pulmonary Heart - Diagnosis

Instrumental studies for pulmonary heart disease:

Electrocardiography

ECG signs of chronic pulmonary heart disease according to Widhmky

Direct ECG signs (due to increased mass of the right ventricle):

• RV1 > 7 mm;
• RV1/SV1 > 1;
• RV1 +RV5 > 10.5 mm;
• right ventricular activation time in V1 0.03-0.05";
• incomplete right bundle branch block and late RV1 > 15 mm;
• signs of right ventricular overload in V1-V2;
• the presence of QRV1 when excluding focal myocardial damage.

Indirect ECG signs (appear at an early stage; often they are caused by a change in the position of the heart):

• RV5 < 5 mm;
• SV5 > 5 mm;
• RV5/SV5 < 1.0;
• incomplete right bundle branch block and late RV1 < 10 mm;
• complete right bundle branch block and late RV1 < 15 mm;
• index (RV5/SV5) /(RV1/SV1) < 10;
• negative T waves 1-5;
• SV1 < 2 mm;
• P pulmonale > 2 mm;
• deviation of the electrical axis of the heart to the right (a> + 110°);
• S-type ECG;
• P/Qв avR > 1.0.

[ 1 ], [ 2 ], [ 3 ], [ 4 ], [ 5 ], [ 6 ], [ 7 ], [ 8 ]

Criteria for right ventricular myocardial hypertrophy

Sokolov-Lyon (1947)

1. RV1 > 7 mm;
2. SV1 < l.0;
3. SV5-6 > 7 mm;
4. RV1 + SV5-6 > 10.5 mm;
5. RV5-6 < 5 mm;
6. R/SV5-6 < 5 mm;
7. (R/SV5)/(R/SV1) < 0.4;
8. R avR > 5 mm;
9. R/SV1 > 1.0;
10. deviation of the electrical axis of the heart to the right is greater than +110°;
11. right ventricular activation time in V1-2 0.04-0.07";
12. decrease and inversion of TV1-2 at R > 5 mm;
13. ST depression avL and T inversion avL or T inversion avR.

[ 9 ], [ 10 ], [ 11 ], [ 12 ], [ 13 ], [ 14 ], [ 15 ]

Rheorrhaphy of the chest

The value of pressure in the pulmonary artery can be determined using a “pulmonary” rheogram using the formula:

Pulmonary artery systolic pressure = 702 * Τ - 52.8 (mmHg)

Diastolic pressure in the pulmonary artery = 345.4 * T - 26.7 (mmHg)

T is the period of right ventricular tension; its duration is equal to the interval from the β wave of the ECG to the beginning of the rise of the rheogram wave.

Echocardiography in pulmonary heart disease

The echocardiographic method has the following capabilities in chronic pulmonary heart disease:

• visualization of the right heart chambers with confirmation of their hypertrophy;
• identification of signs of pulmonary hypertension;
• quantitative assessment of pulmonary hypertension;
• determination of the main parameters of central hemodynamics.

EchoCG reveals the following signs of right ventricular hypertrophy:

• increase in the thickness of the ventricular wall (normally 2-3 mm, average 2.4 mm);
• expansion of the right ventricular cavity (cavity size in terms of body surface area) (average values of the right ventricular index 0.9 cm/m2 ⁾.

Other echocardiographic signs of pulmonary hypertension:

• a decrease in the "a" wave when visualizing the pulmonary artery valve, the mechanism of formation of which is associated with a partial opening of the pulmonary artery valve during atrial systole (normally, the amplitude of the "a" wave is 2-7 mm). This amplitude depends on the diastolic pressure gradient in the right ventricle - pulmonary artery section. An "a" wave amplitude of 2 mm or less is a reliable sign of pulmonary hypertension;
• change in configuration and decrease in the rate of diastolic decline;
• increased speed of pulmonary valve opening and relatively easy detection;
• W-shaped movement of the pulmonary valve crescents in systole;
• increase in the diameter of the right branch of the pulmonary artery (more than 17.9 mm).

[ 16 ], [ 17 ], [ 18 ], [ 19 ]

Chest X-ray

Radiological signs of chronic pulmonary heart disease are:

• enlargement of the right ventricle and atrium;
• bulging of the conus and trunk of the pulmonary artery;
• significant expansion of the root vessels with a depleted peripheral vascular pattern;
• "cut-off" of the roots of the lungs;
• an increase in the diameter of the descending branch of the pulmonary artery (determined on a computed tomogram - 19 mm or more);
• an increase in the Moore index - the percentage ratio of the diameter of the pulmonary artery arch to half the diameter of the chest; the latter is determined by an X-ray in the anteroposterior projection at the level of the right dome of the diaphragm. In pulmonary hypertension, the index increases.

Normally, the Moore index at the age of 16-18 years = 28 ± 1.8%; 19-21 years = 28.5 ± 2.1%; 22-50 years = 30 ± 0.8%.

• increase in the distance between the branches of the pulmonary artery (normally it is 7-10.5 cm).

[ 20 ], [ 21 ]

Radionuclide ventriculography in pulmonary heart disease

Radionuclide ventriculography allows visual examination of the heart chambers and main vessels. The study is performed on a scintillation gamma camera using 99mTc. A decrease in the right ventricular ejection fraction, especially in a test with physical exertion, speaks in favor of pulmonary hypertension.

Study of external respiratory function in pulmonary heart disease

Changes caused by the underlying disease are detected; chronic obstructive bronchitis leads to the development of obstructive respiratory failure (< FVC, < MVL, < MRV); with severe emphysema, a restrictive type of respiratory failure develops (< FVC, < MVL).

[ 22 ], [ 23 ], [ 24 ], [ 25 ], [ 26 ], [ 27 ]

Laboratory data in pulmonary heart disease

Chronic pulmonary heart disease is characterized by erythrocytosis, high hemoglobin levels, slow ESR, and increased tendency to coagulation. In the case of exacerbation of chronic bronchitis, leukocytosis and increased ESR are possible.

Pulmonary heart disease examination program

1. General blood and urine tests.
2. Blood biochemistry: total protein, protein fractions, sialic acids, fibrin, seromucoid.
3. ECG.
4. Echocardiography.
5. X-ray examination of the heart and lungs.
6. Spirometry.

Example of diagnosis formulation

Chronic purulent obstructive bronchitis in the acute phase. Diffuse pneumosclerosis. Emphysema. Stage II respiratory failure. Chronic compensated pulmonary heart disease.

[ 28 ], [ 29 ], [ 30 ], [ 31 ], [ 32 ]