Pulmonary heart: symptoms

The presence of clinical, laboratory and instrumental symptoms of chronic obstructive and other lung diseases, indicated in the article " Pulmonary Heart - Causes and Pathogenesis ", already suggests a diagnosis of a chronic pulmonary heart.

A complex of symptoms caused by respiratory failure and significantly worsening in the formation of a chronic pulmonary heart.

The most important symptom is shortness of breath, which increases with physical exertion; with severe pulmonary hypertension, it can also be observed at rest. The degree of dyspnea is also significantly affected by the degree of bronchial obstruction. Characteristic features of dyspnea are the absence of orthopnea and a decrease in it with the use of bronchodilators and inhalations of oxygen. Patients are also concerned about pronounced weakness, palpitation, pain in the heart. Cardialgia are caused by hypoxia, reflex narrowing of the coronary arteries (pulmonary coronary reflex), a decrease in the filling of the coronary arteries with an increase in the final diastolic pressure in the cavity of the right ventricle. Pain in the heart area is permanent and decreases after inhalation of oxygen.

Extremely characteristic is a warm diffuse gray cyanosis due to arterial hypoxemia. Against the background of chronic hypoxia and hypercapnia, there are constant headaches, drowsiness during the day, insomnia at night, sweating, and appetite decreases.

1. Clinical signs of right ventricular hypertrophy:
   • expansion of the right border of the heart (rarely);
   • displacement of the left border of the heart outside of the mid-succinic line (due to displacement by the enlarged right ventricle);
   • presence of a heartbeat (pulsation) along the left border of the heart;
   • pulsation and better auscultation of cardiac tones in the epigastric region;
   • the appearance of systolic murmur in the region of the xiphoid process, which is intensified by inhalation (the Rivero-Corvallo symptom) is a sign of the relative insufficiency of the tricuspid valve, which develops with an increase in the right ventricle.
2. Clinical signs of pulmonary hypertension (high pressure in the pulmonary artery):
   • an increase in the zone of vascular stupidity in the 2nd intercostal space due to the expansion of the pulmonary artery;
   • the accent of the 2nd tone and its splitting into the 2nd intercostal space on the left;
   • the appearance of a venous network in the sternum;
   • the appearance of diastolic noise in the pulmonary artery in connection with its dilatation (Graham-Still's symptom).
3. Clinical signs of decompensated pulmonary heart:
   • orthopnea;
   • cold acrocyanosis;
   • swelling of cervical veins, not diminishing in inspiration;
   • enlargement of the liver;
   • Symptom Plesha (pressing on the enlarged painful liver causes swelling of the cervical veins);
   • with severe heart failure, it is possible to develop edema, ascites, hydrothorax.

[1], [2], [3], [4], [5], [6], [7], [8], [9]