Pulmonary heart: classification

VP Silvestrov on the basis of the results of clinic-functional studies identified 4 functional classes of the chronic pulmonary heart.

I FK-initial changes (latent hypertension), has the following characteristics:

• in the clinic, the symptoms of chronic bronchopulmonary disease predominate;
• moderate impairment of the ventilation function of the lungs or more often the syndrome of isolated obstruction of small bronchi;
• in the genesis of pulmonary hypertension, the leading role is played by hypoxic vasoconstriction and the restructuring of hemodynamics with the formation of an enlarged IOC (compensatory);
• hyperkinetic type of hemodynamics;
• pulmonary hypertension is detected only under conditions of physical exertion (latent pulmonary hypertension);
• compensatory reactions of the immune system (increase in T-suppressors);
• respiratory insufficiency is absent (DN0);
• there is no circulatory failure (NK0).

II FK - stable pulmonary hypertension moderate, has the following manifestations:

• in the clinic, symptoms of bronchopulmonary disease predominate;
• moderate impairment of external respiration by obstructive type (sometimes significant);
• the formation of pulmonary hypertension is attended by alveolar hypoxia, hypoxic vasoconstriction, an increase in pulmonary vascular resistance;
• pulmonary hypertension stable moderate;
• the restructuring of central hemodynamics, an increase in IOC (compensatory), an overload of the right ventricle;
• type of hemodynamics is hyperkinetic;
• exhaustion of compensatory possibilities of the immune system;
• DN 0-I st;
• НК 0.

III FC - significant pulmonary hypertension, has the following features:

• Symptoms of the underlying disease and severe respiratory failure are joined by signs of beginning heart failure (dyspnea constant, tachycardia, swollen cervical veins);
• there is severe pulmonary hypertension due to the above mechanisms and the violation of the architectonics of the bronchial and vascular tree;
• there are ECG and X-ray signs of hypertrophy and dilatation of the right heart;
• eukinetic type of hemodynamics;
• secondary immunological failure;
• DN II-III ct.
• NK 0-I st.

IV FK-pronounced pulmonary hypertension is characterized by the following features:

• compensatory capabilities of the respiratory and cardiovascular system are exhausted;
• pulmonary hypertension is sharply expressed, is caused by the main disease, alveolar hypoxemia, vasoconstrictor reactions and pronounced structural changes in the vascular bed of the lungs, increased blood viscosity, polycythemia;
• hypokinetic type of hemodynamics;
• secondary immunological failure;
• DN II-III
• NK II-III

Classification of pulmonary hypertension in chronic obstructive pulmonary tuberculosis NR Paleeva successfully complements the classification of pulmonary heart B. Ye. V. Votchala.

• In stage I (transient), the increase in pulmonary arterial pressure occurs during physical exertion, often due to exacerbation of the inflammatory process in the lungs or aggravation of bronchial obstruction.
• II stage (stable) is characterized by the existence of pulmonary arterial hypertension at rest and outside the exacerbation of pulmonary pathology.
• At stage III, stable pulmonary hypertension is accompanied by circulatory failure.

[1], [2], [3], [4], [5]