Pulmonary carcinomatosis: a rare cause of acute cor pulmonale

Five cases of neoplastic pulmonary embolism are reported in whom the clinical presentation was consistent with acute cor pulmonale. Perfusory lung scintigraphy was negative in all the cases. Four patients died within 7 days, one after 30 days from starting of symptoms. At autopsy in all the cases neoplastic diffuse embolization of pulmonary arteries was seen with or without thrombosis. In two cases lymphatic carcinosis was also evident. In the literature the majority of cases are reported to have a subacute clinical course as compared to the acute clinical evolution of our series. We suggest to keep in mind the diagnostic hypothesis of vascular pulmonary carcinosis in the cases of acute cor pulmonale with negative perfusory lung scintigraphy.     

Acute transient cor pulmonale due to foreign body asphyxia

Acute cor pulmonale is a well recognized complication of acute pulmonary embolism. This report describes clinical and electrocardiographic manifestations of very transient cor pulmonale due to asphyxia.     

注射用血塞通治疗慢性肺源性心脏病急性加重期60例临床观察

目的观察注射用血塞通在治疗慢性肺源性心脏病急性加重期的临床疗效。方法将入选病人分为治疗组60例、对照组52例。两组均给予抗感染、利尿、解痉平喘、止咳、祛痰、持续或间断低流量吸氧及对症处理，治疗组同时加用注射用血塞通静脉输注，每日1次，10d～15d为一疗程。结果治疗组总有效56例（93．33％）显著高于对照组的39例（75．00％）。结论注射用血塞通用于治疗慢性肺源性心脏病急性加重期有一定疗效。     

老年慢性肺源性心脏病急性加重期超敏C反应蛋白的临床价值

目的探讨超敏C反应蛋白CRP(hs-CRP)在老年慢性肺源性心脏病(肺心病)急性加重期的临床价值。方法选择2004年9月—2007年10月我院老年肺心病患者急性加重期64例和缓解期60例和健康组65例。检测并比较患者hs-CRP、白细胞(WBC)、血沉(ESR)、痰细菌培养等指标。结果肺心病患者hs-CRP、WBC和ESR均高于健康对照组(P0.05);肺心病患者急性加重期3个指标均高于缓解期(P0.05);急性加重期患者hs-CRP阳性率93.8%,远高于其他指标阳性率。结论hs-CRP检测有助于肺心病加重期感染状态的早期诊断,且其反映抗生素的治疗效果,有一定的临床使用价值。     

Transient right bundle branch block in a patient with acute pulmonary embolism

We report the case of an 86-year-old man found at home with acute chest pain and dyspnea. He presented some episodes of left chest pain combined with dyspnea. The physical examination revealed crackling sounds on the bases of the lungs without other anomalies. Electrocardiograms revealed a transient and complete right bundle branch block with inverted T waves in leads V1, V2, and V3. He was diagnosed with a proximal bilateral acute pulmonary embolism without acute cor pulmonale. We describe a case of a transient bundle branch block, without tachycardia or acute cor pulmonale, revealing a pulmonary embolism.     

重症慢性肺心病患者甲状腺激素水平观察

目的观察慢性肺心病急性加重期患者血清甲状腺激素变化,并探讨其临床意义。方法用放免法测定48例慢性肺心病急性加重期患者(试验组)及45例同期收治的慢性阻塞性肺疾病(COPD)患者(对照组)血清甲状腺激素(T3,T4,FT3,FT4)及促甲状腺素(TSH)水平,并进行比较。结果肺心病组血清T3,T4,FT3均明显低与对照组(P<0.01),FT4轻度下降,但差异无显著性(P>0.05),TSH水平两组比较差异无显著性(P>0.05)。结论慢性肺心病患者血清甲状腺激素水平的变化对肺心病急性加重期病情判断及其预后估计具有一定临床参考价值。     

卡托普利对慢性肺心病患者急性血液动力学及激素变化的研究

以２０例肺心病心力衰竭并呼吸衰竭患者及１１例健康者为对象，进行静脉注射卡托普利治疗肺心病的急性血液动力学及激素变化的临床研究。结果表明，静脉注射卡托普利能快速降低心脏前后负荷，降低肺动脉压力，增加心排血量，同时抑制肾素系统活性，降低血浆甲状腺素及心钠素水平，使急、重症肺心病患者临床症状迅速缓解，但对即刻血气变化无明显影响。     

慢性肺源性心脏病急性发作期的三重酸碱失衡

目的：探讨慢性肺源性心脏病（肺心病）急作发作期的酸碱失衡状况，方法：分析152例肺心病急性发作期患住院期间的461例次动脉血气，血清电解质检测结果和相关临床资料。计算阴离子间隙（AG）和潜在HCO3^-，根据酸碱失衡量化公式，判断酸碱失衡类型。结果：152例肺心病患，发生酸碱失衡133（87．5％），其中三重酸碱失衡15例（9．9％），都有多脏器损害。结论：危重肺心病患三重酸碱失衡，其主要处理原则是治疗原发病，维护脏器功能，维持PH值相对正常。     

Measurement of right and left heart function of COPD and cor pulmonale by radionuclide ventriculography]

Non-invasive measurements of right and left ventricular ejection fraction (RVEF, LVEF) by multiple-gated equilibrium radionuclide ventriculography were performed in 19 control subjects, 55 patients with COPD and cor pulmonale, simultaneous right heart catheterizations were performed in 10 patients with cor pulmonale to determine the mean pulmonary artery pressure (mPAP), and then, the acute hemodynamic and functional effects of nifedipine were evaluated. The mean RVEFs are different significantly among the various groups. With the development of the diseases, the RVEFs reduce gradually. The mean LVEF reduces significantly in cor pulmonale patients with heart failure. The RVEF correlated negatively to mPAP (r = -0.7047, P < 0.01). After nifedipine (20mg), the RVEF and mPAP do not change significantly (P > 0.05), but the artery blood pressure reduces significantly. We conclude that the equilibrium radionuclide ventriculography may be a useful and accurate method in diagnosing early cor pulmonale and cor pulmonale with right heart failure, and nifedipine may not be a good vasodilator for pulmonary hypertension.     

慢性阻塞性肺疾病急性加重期住院病人中肺心病罹患率调查

目的了解慢性肺源性心脏病（肺心病）在慢性阻塞性肺疾病急性加重期（AECOPD）住院病人中的罹患率。方法系统回顾我科2002年10月1日至2007年3月31日住院的1274例AECOPD病人,统计肺心病在各级的罹患率和总罹患率。结果总罹患率为：75．4％。其中,Ⅰ级25．9％,Ⅱa级60．6％,Ⅱb级70．1％,Ⅱ级92．6％。结论肺心病在AECOPD住院病人中罹患率很高,分期越高,罹患率越高。     

老年肺心病急性加重期血小板参数的变化与高凝状态的研究

目的探讨老年肺心病急性加重期血小板4项分析参数的变化及对机体凝血功能的影响。方法分别测定40例老年肺心病急性加重期病人、37例经治疗后的缓解期病人及35名健康老年人的血小板4项参数值,包括血小板计数(PLT)、平均血小板体积(MPV)、血小板压积(PCT)、血小板分布宽度(PDW)。结果老年肺心病急性加重期病人PLT及PCT显著低于经治疗后的缓解期病人及健康老年人(P<0.01);而MPV,PDW则显著增高(P<0.05)。结论老年肺心病急性加重期可通过多种机制引起血小板参数的变化,进而造成机体高凝状态,是血栓及弥散性血管内凝血(DIC)形成的基础,同时对临床判断肺心病的病情及预后有重要意义。     

Pulmonary embolism with and without acute cor pulmonale,with especial reference to the electrocardiogram

Ten patients with acute cor pulmonale, without underlying heart disease, five of whom died (three had post-mortem examinations), are presented with their electrocardiograms to corroborate the observation that there is a typical electrocardiographic pattern in acute cor pulmonale; it is characterized by right axis deviation with a prominent S wave in Lead I, a depressed S-T segment in Lead II and often in Lead I, a Q wave and an inverted T wave in Lead III, and a diphasic or an inverted T wave in Lead IV-F. An upward convexity of the S-T segment in Lead III is common; an elevation of the S-T take-off in this lead occurs in a few cases. The cases were selected so that other factors which of themselves could have modified the electrocardiogram were exeluded.The electrocardiographic changes in an additional series of ninety-two cases of pulmonary embolism were reviewed. Co-existent heart disease occurred in sixty-nine. In twenty-nine cases symptoms of shock predominated; in sixty-three the signs of pulmonary infarction without shock or collapse predominated. Electrocardiographic changes that were considered indicative of acute cor pulmonale were present in sixteen of the former group, and in seventeen of the latter. In other words, the electrocardiogram gave indication of some degree of acute cor pulmonale in a little more than one-half of the cases when shock predominated, in a little less than one-quarter of the group without shock, and in about one-third of the entire series, including those patients who had abnormal electrocardiograms as a result of heart disease.It is emphasized that “pulmonary embolism” and “acute cor pulmonale” are not synonymous terms. It appears that varying degrees of acute cor pulmonale occur, and that the electrocardiogram provides a means of evaluating the status of the heart, especially when clinical signs indicative of right-sided heart strain are not obvious.It is our belief that anoxemia produced by a pulmonary embolus may cause infarction in cardiae muscle which is already the seat of severe coronary artery disease. When this occurs, the electrocardiographic changes are confusing and atypical.Death is often caused by a second or third embolus. Prophylactic leg exercises, venography, and, if indicated, ligation of the femoral vein should reduce the incidence of fatal pulmonary emboli.     

低分子肝素钙与硝酸甘油雾化吸入对肺心病急性发作期的临床研究

目的观察硝酸甘油、低分子肝素钙经氧气驱动雾化给药对肺心病急性发作期患者血气分析及肺动脉压力的影响。方法对120例肺心病急性发作期患者分3组：A组：射流雾化吸入硝酸甘油10 mg＋生理盐水2 ml,每日2次,每次15min,疗程7 d;B组：射流吸入低分子肝素钙4100 IU加生理盐水2 ml,每日2次,每次15 min,疗程7 d;C组：硝酸甘油10 mg＋低分子肝素钙4100 IU射流雾化,每日2次,每次15 min,疗程7 d。治疗前后监测动脉血气分析、及肺动脉压力变化情况。结果血气及肺动脉压力的变化每组治疗前后差异均有显著性（P〈0.05）,C组与A、B组比较,PaO2及肺动脉压力改善更明显（P〈0.01）。结论肺心病急性发作期患者联合吸入硝酸甘油与低分子肝素钙,具有改善血气及肺动脉压作用快而直接,能明显缓解血液高粘状态,改善微循环,纠正心肺功能不全效果显著。     

Relation of the electrocardiogram to hemodynamic alterations in pulmonary embolism

In 20 consecutive cases of pulmonary embolism in a group of patients free of underlying cardiopulmonary disease the frequency of electrocardiographic changes was observed and related to hemodynamic status. A wide range of embolic obstruction (13 to 68 percent) was shown by angiography and was accompanied by hemodynamic abnormalities ranging from minimal impairment to acute cor pulmonale. Only 1 patient showed diagnostic electrocardiographic changes of right ventricular strain; in 3 the electrocardiogram was suggestive. All 4 had the hemodynamic findings of acute cor pulmonale. No. other patient did. It was clinically clear in all 4 patients that a cardiopulmonary catastrophe had occurred, and the diagnoses of acute myocardial infarction and acute massive pulmonary embolism were immediately considered.     

Serum soluble Fas in patients with Schistosomal cor pulmonale

BACKGROUND: Schistosomal cor pulmonale is considered an important pathological condition in endemic areas. Few recent studies have reported the role of apoptosis in pulmonary hypertension. OBJECTIVES: The aim of this study was to assess serum levels of soluble Fas (sFas), an inhibitor of apoptosis, in patients with schistosomal cor pulmonale as compared to patients with cor pulmonale due to chronic obstructive pulmonary disease (COPD) and normal subjects. METHODS: Serum sFas was assessed in 15 men with schistosomal cor pulmonale (age 32 +/- 10 years), 15 men with chronic cor pulmonale secondary to COPD and 20 healthy men, matched for age. RESULTS: Serum levels of sFas were significantly higher in patients with schistosomal cor pulmonale (74 +/- 80 U/ml) than in patients with cor pulmonale due to COPD (15 +/- 10 U/ml) and normal subjects (19 +/- 11 U/ml, p < 0.001 in both). In patients with schistosomal cor pulmonale, sFas was significantly higher in patients with mean pulmonary artery pressure > 30 mm Hg as compared to patients with pressure < or = 30 mm Hg (109 +/- 97 vs. 34 +/- 20 U/ml, p = 0.01). There was a significant correlation between serum sFas and the mean pulmonary artery pressure in patients with bilharzial cor pulmonale (r = 0.4, p < 0.01), but not in patients with COPD (r = 0.1, p = NS). CONCLUSIONS: Serum sFas levels are elevated in patients with schistosomal cor pulmonale and they are related to the severity of pulmonary hypertension. These findings suggest a role of apoptosis in schistosomal cor pulmonale.     

46例老年肺心病病理与临床对比分析

目的总结临床诊断老年肺心病的成功经验与失败教训。方法对４６例老年肺心病病例以病理解剖与临床资料对照的方法，从发病年龄、临床误诊率、临床漏诊率、病因、死亡原因、右室壁平均厚度与病程和死亡年龄的关系以及肺心病伴发冠心病等方面进行分析。结果本组老年肺心病平均发病年龄为６５岁。肺心病临床总误诊率达２７％，总漏诊率６％。肺心病病因以慢性支气管炎、肺气肿最常见占８４％。其死亡原因以呼吸衰竭和全心衰竭为主占５３％。平均右室壁厚度随肺心病病程和死亡年龄升高而增加。肺心病伴发冠心病者占４１％。结论以上结果表明老年肺心病临床误诊率较高，应严格掌握肺心病诊断标准以降低临床误诊率。积极降低慢性支气管炎和肺气肿的发病率仍是预防肺心病的重要环节。老年肺心病伴发冠心病的比率较高应引起重视。努力防治呼吸衰竭和心力衰竭能够有效的降低老年肺心病的死亡率。     

An overlooked electrocardiographic sign of acute embolic cor pulmonale: elevation of the ST segment in right precordial leads

Elevation of the ST segment in the right precordial leads may be associated with electrocardiographic signs of acute cor pulmonale. This sign, which we have observed in 77 cases of moderate to severe pulmonary embolism (greater than 1.3 per cent of cases), is a very early but transient sign of usually moderate to severe pulmonary embolism. In the presence of this sign, the diagnosis of pulmonary embolism with acute cor pulmonale should be proposed at the same time as more common aetiologies such as coronary insufficiency and pericardial disease.     

Lungenemphysem—Silikose—Cor pulmonale Ergebnisse statistischer Untersuchungen

Clinical and pathologic-anatomical investigations show differing results regarding the question, as to whether or not pulmonary emphysema and silicosis produce cor pulmonale. Therefore we have investigated the autopsy findings over a 10-year period with statistical methods. We wanted to determine correlations between cor pulmonale and pulmonary emphysema and between cor pulmonale and silicosis; also to be determined was if the combination of such pulmonary changes with cor pulmonale is statistically accidental and/or significant. Finally, we wanted to know, if there are correlations between the frequency of cor pulmonale and grading of silicosis.The documentation of the lung findings was done in most cases after fixation of the lungs and slicing of the discs. The hearts were fixed in formaldehyde; the amount of fat-free myocardium of the right and left ventricle and the septum was determined (method W. Müller, 1883).From 1960 to 1969 there were 5,983 autopsies evaluated in our institute. Of these cases, 1,507 cases were with lung emphysema and anthraco-silicosis. We have not evaluated the autoptic findings in children and young adults up to 30 years of age, or in patients with heart failure and hearts weighing more than 500 gr., myocarditis, tuberculosis, lung fibrosis, bronchus carcinoma and patients with diseases of the hemopoetic system.Our investigation showed the following results: 1,430 patients had different types of lung emphysema. 40.5% of these cases were combined with a cor pulmonale. With the “two-point-two-table chi-square-test” we found a significant correlation between lung emphysema and cor pulmonale.There were 542 patients with anthraco-silicosis from the Aachen area. 511 of these 542 patients also had concurrent lung emphysema. In 48.5% of those patients with silicosis, we found morphological signs of cor pulmonale. The correlations between silicosis and cor pulmonale had a high statistical significance. In contrast to these findings, we found no statistical correlation between grading of silicosis and cor pulmonale. These results are discussed and compared with the results from the literature.     

Lungenemphysem—Silikose—Cor pulmonale Ergebnisse statistischer Untersuchungen

Clinical and pathologic-anatomical investigations show differing results regarding the question, as to whether or not pulmonary emphysema and silicosis produce cor pulmonale. Therefore we have investigated the autopsy findings over a 10-year period with statistical methods. We wanted to determine correlations between cor pulmonale and pulmonary emphysema and between cor pulmonale and silicosis; also to be determined was if the combination of such pulmonary changes with cor pulmonale is statistically accidental and/or significant. Finally, we wanted to know, if there are correlations between the frequency of cor pulmonale and grading of silicosis. The documentation of the lung findings was done in most cases after fixation of the lungs and slicing of the discs. The hearts were fixed in formaldehyde; the amount of fat-free myocardium of the right and left ventricle and the septum was determined (method W. Müller, 1883). From 1960 to 1969 there were 5,983 autopsies evaluated in our institute. Of these cases, 1,507 cases were with lung emphysema and anthraco-silicosis. We have not evaluated the autoptic findings in children and young adults up to 30 years of age, or in patients with heart failure and hearts weighing more than 500 gr., myocarditis, tuberculosis, lung fibrosis, bronchus carcinoma and patients with diseases of the hemopoetic system. Our investigation showed the following results: 1,430 patients had different types of lung emphysema. 40.5% of these cases were combined with a cor pulmonale. With the “two-point-two-table chi-square-test” we found a significant correlation between lung emphysema and cor pulmonale. There were 542 patients with anthraco-silicosis from the Aachen area. 511 of these 542 patients also had concurrent lung emphysema. In 48.5% of those patients with silicosis, we found morphological signs of cor pulmonale. The correlations between silicosis and cor pulmonale had a high statistical significance. In contrast to these findings, we found no statistical correlation between grading of silicosis and cor pulmonale. These results are discussed and compared with the results from the literature.     

COPD合并慢性肺源性心脏病与否的肺功能对比分析

目的 通过对单纯COPD与肺心病患者的肺功能进行对比分析,了解COPD合并肺心病与否时的肺功能改变.方法 对所有入选的COPD患者进行肺功能和心脏超声检查,COPD患者GOLD分级为Ⅱ～Ⅳ级.根据有无肺心病将入选患者分为单纯COPD组和COPD合并肺心病组.单纯COPD组37例;COPD合并肺心病组31例.结果 COPD合并肺心病组DLCO% pred显著低于单纯COPD组(P<0.05);两组间FEV1% pred、FVC% pred、FEV1/FVC、RV% pred、TLC% pred、RV/TLC和共振频率无显著差异(P＞0.05).结论 COPD合并肺心病患者较单纯COPD患者肺弥散功能的损害更为显著.