Single center case-control study on influencing factors of renal injury in elderly patients with cor pulmonale / 公共卫生与预防医学

Objective To explore the influencing factors of renal injury in elderly patients with cor pulmonale, and to provide information for the prevention of renal injury in patients with cor pulmonale. Methods A total of 309 elderly patients with cor pulmonale over 60 years old treated in our hospital from June 2019 to December 2020 were included in the study. According to the patients with renal injury , they were divided into cor pulmonale renal injury group (case group) and cor pulmonale non renal injury group (control group). The basic information of the two groups and the influencing factors of potential renal injury in the past were collected, The influencing factors of renal injury in elderly patients with cor pulmonale were analyzed by univariate analysis and regression model. Results The single factor analysis of the case group was higher than that of the control group, with a male age of 80 years, smoking history, family history of diabetes, concurrent infection, diabetes mellitus and left ventricular ejection fraction (LVEF) 80 years old (or = 3.142), smoking history (or=2.115) , concurrent infection (or=4.263) , and excessive systolic blood pressure (or=2.279) were the risk factors potentially increasing the risk of renal injury, which were statistically significant (P < 0.05). Conclusion Elderly patients with cor pulmonale over 80 years old , with smoking history and abnormal blood pressure , as well as those complicated with infection , have an increased risk of renal injury. It is worthy of clinical attention and relevant preventive measures to improve the prognosis of patients.

Pathogenesis of acute cor pulmonale in children / 中国小儿急救医学

Acute cor pulmonale, usually secondary to pulmonary hypertension induced from severe pulmonary diseases or pulmonary circulation disorders, is characterized by acute right heart dysfunction and right heart failure.Hypoxemia, hypercapnia and positive pressure ventilation can all lead to pulmonary hypertension.During the treatment of critically ill children, especially in the process of respiratory support, acute cor pulmonale should be identified as soon as possible to consider the implementation of "lung protection" and "circulation protection" with monitoring of right heart function and protection as the core.

Efeitos do Óleo de Copaíba em Marcadores Periféricos de Estresse Oxidativo em um Modelo de Cor Pulmonale em Ratos / Effects of Copaiba Oil in Peripheral Markers of Oxidative Stress in a Model of Cor Pulmonale in Rats

Resumo Fundamento Até o presente momento, os efeitos sistêmicos do óleo de copaíba jamais foram documentados no Cor pulmonale induzido por monocrotalina. Objetivos Investigar os efeitos do óleo de copaíba nos marcadores periféricos de stress oxidativo em ratos com Cor pulmonale. Métodos Ratos Wistar machos (170±20g, n=7/grupo) foram divididos em quatro grupos: controle (CO), monocrotalina (MCT), óleo de copaíba (O), e monocrotalina + óleo de copaíba (MCT-O). Foi administrada a MCT (60 mg/kg i.p.) e, depois de uma semana, foi iniciado o tratamento com óleo de copaíba (400 mg/kg/day-gavagem-14 dias). Foi realizado o ecocardiograma e, depois disso, foi coletado sangue do tronco para a realização de avaliações de stress oxidativo. Análise estatística: ANOVA de duas vias com teste Student-Newman-Keuls post hoc. P-valores <0,05 foram considerados significativos. Resultados O óleo de copaíba reduziu a resistência vascular pulmonar e a hipertrofia do ventrículo direito (VD) hipertrofia (Índice de Fulton (mg/mg)): MCT-O= 0,39±0,03; MCT= 0,49±0,01), e função sistólica melhorada (fração de encurtamento do VD, %) no grupo MCT-O (17,8±8,2) em comparação com o grupo de MCT (9,4±3,1; p<0,05). Além disso, no grupo MCT-O, espécies reativas do oxigênio e os níveis de carbonila foram reduzidos, e os parâmetros antioxidantes aumentaram no sangue periférico (p <0,05). Conclusões Os resultados deste estudo sugerem que o óleo de copaíba tem um efeito antioxidante sistêmico interessante, que se reflete na melhoria da função e na morfometria do VD nesse modelo de Cor pulmonale . A atenuação do Cor pulmonale promovida pelo óleo de copaíba coincidiu com uma redução no stress oxidativo sistêmico.

Abstract Background To date, copaiba oil's systemic effects have never documented in Cor pulmonale induced by monocrotaline. Objectives To investigate copaiba oil's effects in peripheral markers of oxidative stress in rats with Cor pulmonale. Methods Male Wistar rats (170±20g, n=7/group) were divided into four groups: control (CO), monocrotaline (MCT), copaiba oil (O), and monocrotaline+copaiba oil (MCT-O). MCT (60 mg/kg i.p.) was administered, and after one week, treatment with copaiba oil (400 mg/kg/day-gavage-14 days) was begun. Echocardiography was performed and, later, trunk blood collection was performed for oxidative stress evaluations. Statistical analysis: two-way ANOVA with Student-Newman-Keuls post-hoc test. P values<0.05 were considered significant. Results Copaiba oil reduced pulmonary vascular resistance and right ventricle (RV) hypertrophy (Fulton index (mg/mg): MCT-O=0.39±0.03; MCT=0.49±0.01), and improved RV systolic function (RV shortening fraction, %) in the MCT-O group (17.8±8.2) as compared to the MCT group (9.4±3.1; p<0.05). Moreover, in the MCT-O group, reactive oxygen species and carbonyl levels were reduced, and antioxidant parameters were increased in the peripheral blood (p<0.05). Conclusions: Our results suggest that copaiba oil has an interesting systemic antioxidant effect, which is reflected in the improvements in function and RV morphometry in this Cor pulmonale model. Cor pulmonale attenuation promoted by copaiba oil coincided with a reduction in systemic oxidative stress.

A Study of ECG and Echocardiographic Findings in Chronic Obstructive Pulmonary Disease Patients in a Tertiary Care Hospital

COPD has considerable effects on cardiac functions. Most of the increased mortality and morbidity associated with COPD is due to cardiac involvement. We wanted to assess the electrocardiographic and echocardiographic findings in COPD, correlate these findings in assessing the severity and duration of the disease, analyse these findings in assessing right ventricular dysfunction and compare the results of clinical, electrocardiographic and echocardiographic findings in detecting right ventricular dysfunction in COPD. METHODS50 COPD patients fulfilling the inclusion criteria were recruited. They were staged by PFT and evaluated by ECG and echocardiography. Statistical analysis of correlation was done, and statistical significance was taken as p < 0.05. RESULTSAmong the total of 50 cases selected for study 80 % were males, 20 % were females. On the basis of GOLD guidelines there were 8 %, 44 %, 36 %, 12 % mild, moderate, severe and very severe COPD cases respectively. Symptoms at presentation were cough with sputum (92 %), breathlessness (96 %), swelling of feet (24 %), fever (16 %), and decreased urine output (4 %). Physical signs at presentation were tachypnoea (68 %), loud P2 (24 %), parasternal heave (20 %), raised JVP (24 %), pedal oedema (16 %) and ascites (4 %). ECG findings analysis were P-pulmonale (46 %), RAD (38 %), RVH (34 %), low voltage complexes (30 %), poor progression of r-wave (30 %) and incomplete RBBB (12 %). Correlation of all the above ECG findings showed statistical significance (p < 0.05) with disease severity and disease duration (p < 0.05). Echocardiographic findings were pulmonary hypertension (50 %), Cor pulmonale (44 %), RV dilatation (44 %), RA dilatation (32 %), RVH (24 %), interventricular septal motion abnormality (14 %), LVDD (16 %), LVSD (4 %) and RVSD (4 %). All the above echocardiographic findings of RV dysfunction i.e. PAH, Cor pulmonale, RA dilatation, RVD, RVH and RVSD were statistically significant with disease severity and duration (p < 0.05) along with LVDD, LVSD. CONCLUSIONSThis study emphasises on early cardiac screening of all COPD patients which will be helpful in the assessment of the prognosis and will further assist in identifying the individuals likely to suffer increased morbidity and mortality.

Utility of Echocardiography in Cardiac Evaluation of COPD Patients and Its Relationship with Severity of Disease

COPD is a leading cause of death and disability worldwide as well as in India. It is a multisystem disorder among which cardiac manifestations are common. Echocardiography provides a rapid, non-invasive, portable, and accurate method to evaluate such changes. We wanted to assess the cardiac changes due to COPD by echocardiography, evaluate the correlation between echocardiographic findings and severity of COPD using GOLD guidelines (2011 updates).METHODSThis study was a hospital based cross sectional study conducted in M.L.B. Medical College, Jhansi (U.P.). The study included admitted COPD patients in Internal Medicine Department and T.B. Chest Department. The study was conducted after obtaining permission from the Institutional Ethics Committee and identity of the patients has not been revealed.RESULTSOut of 200 admitted patients, 98 patients had cor pulmonale and were further classified by using GOLD guidelines 2017. Upon comparing FEV1 with mPAP in each group we observed p value of 0.001 which is statistically significant. A positive correlation was also found between duration from onset of the disease and mPAP.CONCLUSIONSBy estimating PAP early in the disease process, even in those patients who are not able to perform lung function test correctly due to other co-morbidities, we can determine the progression of the disease and can achieve a better outcome by planning a more appropriate and intense line of management.

Etiology and clinical profile in chronic cor pulmonale

Background: Cor pulmonale is a synonym for pulmonary heart disease. The term 揷or pulmonale� if broken into its constituents 揷or� (heart) and 損ulmo� (lungs), means cardiac involvement due to pulmonary diseases. Chronic cor pulmonale is not a single disease entity but resulting secondary to many bronchopulmonary vascular diseases and also from thoracic cage abnormalities. Cor pulmonale accounts for 5-10% of all heart diseases, 20-30% of all admissions for heart failure and 9.2% in the cardiac autopsies.Methods: This was a hospital-based study carried among patients diagnosed with chronic cor pulmonale admitted to the medical wards of Karnataka institute of medical sciences, Hubli. during December 2011- November 2012 using simple random sampling method.Results: The following observations were made in 50 representative cases the age group of patients was between 24 to 85 years. Chronic cor pulmonale was commonly seen in middle and elderly age groups. Incidence below 35 years is very less. Almost every patient of chronic cor pulmonale presented with breathlessness and cough. All patients in the study had Tachypnoea, Diminished chest movements, Prominent use of accessory muscles of respiration, Cyanosis, Clubbing (in some patients), Crepitations and rhonchi on chest auscultation, Loud P2 and pansystolic murmur in Tricuspid area on cardiac auscultation.Conclusions: The peak incidence of chronic cor pulmonale was found to be in the middle and older age groups with high incidence during winter season. Smoking and dusty environment at the site of occupation were aggravating the primary lung disease. Breathlessness, cough and edema of the feet were the most common symptoms.

Cor pulmonale secondary to pulmonary tuberculosis in pregnancy: A report of two cases / Philippine Journal of Obstetrics and Gynecology

@#Cor pulmonale is defined as alteration in structure and function of the right ventricle of the heart caused by a primary disorder of the lungs. Presented are two cases of gravidocardiac patients from cor pulmonale secondary to multi-drug resistant tuberculosis. The first case is a case of a 37-year-old gravida 4 para 3 (3-0-0-3) and the second case is that of a 24-year-old pimigravid, both of which were on their third trimester with no known cardiac disease, both initially presenting with dyspnea and heart failure symptoms. The first patient was not in labor, managed conservatively and was discharged clinically improved; the latter was delivered abdominally who later succumbed to fatal arrhythmia. Presented are the strategies in management and challenges encountered in managing a pregnant cardiac patient from cor pulmonale, specifically from pulmonary tuberculosis.

Unusual case of intraoperative acute cor pulmonale during spine surgery

Perioperative complications of prolonged surgery and prone positioning are well known. Changing the position from prone to supine in an anesthetized patient can result in aspiration and airway obstruction. The drop-in oxygen saturation and hemodynamic changes are warning signs and can cause acute cardiac decompensation leading to diagnostic dilemma. We present a case where the patient had these changes after changing the position after spine surgery in prone position. A quick response from the treating anesthesiologist and active involvement of cardiologist helped in reaching the diagnosis and successful management of aspiration pneumonitis in this patient. We conclude that a quick response in investigations and multimodality approach helps in the management of such perioperative complications.

Echocardiographic findings in patients with chronic obstructive pulmonary disease

Background: Chronic obstructive pulmonary disease (COPD) is a common respiratory condition involving the airways and characterized by airflow limitation. Pulmonary hypertension (PH) is a well-known predictor of increased morbidity and mortality in COPD. The present study was done to assess the cardiac changes in patients diagnosed with COPD in this department using two-dimensional echocardiography.Methods: This observational study was conducted on fifty patients admitted with signs and symptoms suggestive of COPD in the Department of Pulmonary Medicine, Dr. DY Patil Medical College, Navi Mumbai from January 2018 to December 2018. Pulmonary function tests (PFT) were done in all and patients were graded according to the severity of COPD with guidelines given by Global initiative for Obstructive Lung Disease (GOLD). Comprehensive two-dimensional echocardiography was performed.Results: The most common age group was 60 to 69 years. There were 68% males and 32% females. Mean body mass index of the patients included in the study was 27.8±8.13 kg/m2. COPD according to the GOLD classification was mild, moderate, severe and very severe in 12%, 36%, 30% and 22% of the patients. PH was diagnosed in 56% of the patients, Cor pulmonale in 54%, right ventricular dilatation in 48%, right atrial dilatation in 38%, inter-ventricular septal wall motion abnormality in 18% and right ventricular failure in 14% of the patients.Conclusions: Echocardiography examination is a reliable method in COPD patient to assess PH and helps in early detection of cardiac complications in COPD cases giving time for early interventions.

Evaluation Of Pulmonary Hypertension In Chronic Obstructive Pulmonary Disease

Introduction: The early detection and treatment of pulmonary hypertension in chronic obstructive pulmonary disease (COPD) becomes important to prevent right heart failure. We aimed to pulmonary hypertension in COPD patients by non-invasive methods.Materials and Methods: After Ethical committee clearance, the purpose of the study was explained to the patient and obtained informed consent from 105 Clinically diagnosed as COPD were included and ECG, Chest X-Ray, 2-D Echocardiography pulmonary hypertension is evaluated.Results: Of 105 COPD patients, 96 had PH. Prevalence of pulmonary hypertension in COPD patients were 54 (51.43%): 9 (25.71%) of mild COPD patients, 16 (45.71%) of moderate COPD and 29 (82.85%) of severe COPD.Conclusion: the chest radiography electrocardiography and 2 D-Echocardiography are the best clinical assessment and non-invasive investigations for the screening for pulmonary hypertension and subsequent development of cor pulmonale.

Advances in right ventricular protective ventilatory strategy for acute respiratory distress syndrome / 中国小儿急救医学

Acute respiratory distress syndrome ( ARDS) is a devastating clinical syndrome with the condition of dyspnea,characterized by rapidly progressive hypoxemia with noncardiogenic pulmonary edema. Current therapeutic strategies are based on improving oxygenation and pulmonary compliance while minimizing ventilator-induced lung injury. However,many previous studies had found that the leading risk of ARDS patient′s death is circulatory collapse rather than pulmonary injury or hypoxemia. Additionally,acute cardiac dysfunc-tion caused by increased pulmonary vascular resistance is an important cause of circulatory failure. Besides,with the deepening of the studies,the dysfunction of lung and heart in ARDS patients,also known as severe acute cor pulmonale (ACP),has been shown to be associated with the pathophysiological process of the ARDS and could lead to the increase of right ventricular pressure load,which eventually might result in right ventricular failure. Furthermore,the inappropriate mechanical ventilation could also lead to right ventricular failure,and therefore it′s necessary to closely monitor the function of right ventricular in ARDS patients. To conclude,we will intro-duce the protective ventilation strategy of right ventricular preliminarily in this review.

Cardiorespiratory evaluation of brachycephalic syndrome in dogs / Avaliação cardiorespiratória da síndrome braquiocefálica em cães

Brachycephalic syndrome (BS) in dogs is characterized by the combination of primary and secondary upper respiratory tract abnormalities and may result in significant upper airway obstruction. It can trigger inspiratory dyspnea, culminating in secondary respiratory distress, soft tissue edema, upper airway obstruction, turbulent airflow, inspiratory noise, and even death. These changes lead to increased resistance of the air passages, which can cause elevation of pulmonary pressure and clinical manifestations attributable to pulmonary hypertension. The consequence is right-sided cardiac remodeling (Cor pulmonale) with possible progression to right congestive heart failure. To investigate the effects of BS on the cardiovascular system, 28 animals were recruited for a prospective study and assigned to either the Brachycephalic Group (BG), composed of 22 French bulldogs with BS or the Control Group (CG), which was composed of 6 healthy Beagle dogs. All animals underwent a detailed physical examination, as well as laboratory analyses, electrocardiography, echocardiography, chest radiography and indirect measurement of systemic arterial blood pressure. The most relevant finding was a lower PaO2 (90.6±12.9mmHg) in BG as compared to CG (104.9±5.2), (p≤0.05), possibly attributable to hypoventilation due to anatomical alterations.(AU)

A síndrome braquicefálica (BS) é caracterizada pela combinação de anormalidades primárias e secundárias do trato respiratório superior em cães, podendo resultar em obstrução significativa das vias aéreas superiores. Pode desencadear dispneia inspiratória, culminando em dificuldade respiratória secundária, edema de tecidos moles, obstrução das vias aéreas superiores, fluxo de ar turbulento, ruído inspiratório e até morte. Essas alterações levam ao aumento da resistência da passagem do ar, o que pode causar elevação da pressão pulmonar e manifestações clínicas atribuídas à hipertensão pulmonar. A consequência é o remodelamento cardíaco do lado direito (Cor pulmonale) com possível progressão para insuficiência cardíaca congestiva direita. A fim de averiguar os efeitos da BS sobre o sistema cardiovascular, 28 animais foram recrutados para um estudo prospectivo e distribuídos em Grupo Braquicefálico (GB), composto por 22 Bulldogs franceses com síndrome braquicefálica ou Grupo Controle (GC), composto por 6 cães Beagles saudáveis. Todos os animais foram submetidos a exame físico detalhado, bem como análises laboratoriais, eletrocardiografia, ecocardiografia, radiografias torácicas e mensuração indireta de pressão arterial sistêmica. Os achados mais relevantes foram relacionados ao GB (90,6±12,9mmHg) com menor PaO2 em relação ao GC (104,9±5,2), (p≤0,05), possivelmente atribuível à hipoventilação, em decorrência das alterações anatômicas.(AU)

Effects of acute respiratory distress syndrome induced by endotoxin on the right ventricular function in rats / 中华危重病急救医学

Objective To explore the effect of acute respiratory distress syndrome (ARDS) induced by endotoxin on the right ventricular function in rats. Methods Sixty male Sprague-Dawley (SD) rats were randomly divided into normal saline (NS) control group and lipopolysaccharide (LPS) model group with 30 rats in each group. The rat model of ARDS was reproduced by intratracheal instillation of LPS 10 mg/kg after tracheotomy, and the rats in NS control group was intratracheally given the same volume of NS instead of LPS. The survival of rats in each group was observed. Right ventricular function was evaluated by echocardiography at 6 hours and 12 hours after instillation of LPS or NS respectively. Then the rats were sacrificed by bloodletting, and the right heart and lung tissue were harvested. The lung wet/dry weight (W/D) ratio was assessed. The pathological changes in cardiopulmonary tissue in rats were observed with hematoxylin and eosin (HE) strain, and the pathological score of lung injury was calculated. Results There was no animal death in NS control group. In LPS model group, there were 3 rats dead at 6 hours, and 4 dead at 12 hours. The pathological manifestations of lung injury were found at 6 hours after instillation of LPS, and the marked pathological changes of ARDS, such as atelectasis and hyaline membranes were observed at 12 hours. There was no obvious abnormality in the lung tissue of the NS control group. Compared with the NS control group, the 12-hour lung W/D ratio and the lung injury pathological score in the LPS model group were significantly increased (lung W/D ratio:7.69±1.02 vs. 4.14±0.48, lung injury pathological score: 8.26±2.12 vs. 1.32±0.94, both P < 0.01). Echocardiography showed that the right heart function of rats was significantly abnormal with the prolongation of LPS induction time, which showed that pulmonary arterial diameter (PAD) and right ventricular diastolic diameter (RVDd) were increased, maximum blood flow velocity of pulmonary artery (PAVmax), maximum pulmonary artery pressure gradient (PAmaxPG),pulmonary artery acceleration time (PAAT) and tricuspid annular plane systolic excursion (TAPSE) were decreased, with significant differences at 12 hours as compared with those of NS normal group [PAD (mm): 2.84±0.31 vs. 2.11±0.37, RVDd (mm): 4.18±0.71 vs. 3.17±0.40, PAVmax (mm/s): 704.00±145.13 vs. 809.59±120.48, PAmaxPG (mmHg, 1 mmHg = 0.133 kPa): 2.07±0.88 vs. 2.73±0.76, PAAT (ms): 23.80±4.87 vs. 30.01±3.02, TAPSE (mm): 2.48±0.45 vs. 3.56±0.40, all P < 0.01]. Pathological examination showed that the cardiac tissue in the LPS model group showed disorder of myocardial cells and scattered inflammatory cells at 6 hours, and cardiomyocyte degeneration, structural destruction and inflammatory cells were found at 12 hours. Conclusion ARDS induced by instillation of LPS at 12 hours causes right ventricular dysfunction in rats.

Acute cor pulmonale in acute respiratory distress syndrome / 中华危重病急救医学

Acute respiratory distress syndrome (ARDS) is a severe respiratory condition that is characterized by rapidly progressive hypoxemia with noncardiogenic pulmonary edema.Despite the improvement of therapeutic methods,the mortality of ARDS is in the range of 40％-50％ all over the world.Some studies have shown that a significant number of patients with ARDS had acute cor pulmonale (ACP),and ACP is independently associated with the mortality of patients with ARDS,which has attracted wide attention in recent years.This paper reviewed recent related studies,summarized the prevalence,pathogenesis and diagnostic approaches of ACP in ARDS,especially echocardiography which was considered as a cornerstone for ACP diagnosis,and elucidated the beneficial effects of right ventricular protective ventilatory strategy and prone-positioning on the pulmonary vasculature and right heart,in order to provide a novel idea for the therapy of ACP in ARDS.

Effect of phentolamine on N terminal B-type natriuretic peptide precursor,blood gas analysis,hypersensitive c-reactive protein and plasma D-dimer in patients with chronic cor pulmonale / 中国综合临床

Objective To observe the influence of phentolamine on N terminal B-type natriuretic peptide precursor(NT-proBNP),blood gas analysis,hypersensitive c-reactive protein and plasma D-dimer in patients with chronic cor pulmonale Methods One hundred and one cases patients with chronic cor pulmonale were randomly divided into two groups,51 patients in the treatment group,50 patients in the control group.All patients were treated with normal anti-infection,eliminating phlegm to smooth wheezing antithrombotic for one week,as the same time patients in the treatment group were treated with phentolamine for one week.Through observed the treatment effect of phentolamine to chronic cor pulmonale,the level of NT-proBNP,blood gas analysis,hypersensitive c-reactive protein and plasma D-dimer in patients with chronic cor pulmonale before and after the treatment were analyzed.Results Compared with before treatment,the levels of NT-proBNP,PCO2,hypersensitive c-reactive protein,plasma D dimer were lower than after one week in two groups,while the level of PO2 was higher.Treatment group:NT-proBNP (1 712.76±572.32) ng/L vs.(271.59±163.05) ng/L,t=20.42,P<0.05,PCO2 (66.34±5.81) mmHg vs.(52.58±5.82) mmHg,t=16.46,P<0.05,PO2 (59.28±6.13) mmHg vs.(73.64±6.10) mmHg,t=23.02,P<0.05,hypersensitive c-reactive protein 86.0(28.0) mg/L vs.23.0(12.0) mg/L,Z=-6.22,P<0.05 mg/L,plasma D-dimer (4 953.37±1 654.09) μg/L vs.(1 847.90±838.66) μg/L,t=17.11,P<0.05.Control group:NT-proBNP (1 527.24±658.70) ng/L vs.(612.58±357.59) ng/L,t=14.52,P<0.05,PCO2 (65.41±5.23) mmHg vs.(56.46±5.65) mmHg,t=13.04,P<0.05,PO2(60.57±5.84) mmHg vs.(67.21±5.19) mmHg,t=-10.06,P<0.05,hypersensitive c-reactive protein 79.0(29.0) mg/L vs.43.0(20.0) mg/L,Z=-6.16,,P<0.05,plasma D-dimer (4 408.02±1 682.83) μg/L vs.(2 598.28±1 242.73) μg/L,t=12.15,P<0.05.But the levels of NT-proBNP,PCO2,hypersensitive c-reactive protein and plasma D-dimer reduced significantly,the level of PO2 increased more significantly in treatment group(t(z)=-6.19,-3.39,-7.16,-3.56,5.70,all P<0.05).Conclusion Phentolamine can reduce the level of NT-proBNP,PCO2,hypersensitive c-reactive protein and plasma D-dimer and increased the level of PO2 in patients with chronic cor pulmonale.Phentolamine combined with routine treatment can improve the clinical efficacy of patients with chronic cor pulmonale.

Effect of Qishen Yiqi droplet on adenylate contents in myocardium of cor pulmonale rats / 中国中药杂志

Cor pulmonale rat models were induced by a single intraperitoneal injection of monocrotaline(MCT), and the sham group received a single intraperitioneal injection of normal saline. After the model rats received intragastric administration of Qishen Yiqi droplet(QS) for 6 weeks, the contents of adenylate(ATP, ADP and AMP) in right myocardial tissues were measured by HPLC, and then the metabolism changes in myocardium of cor pulmonale rats with QS were investigated. The results showed that ATP, ADP, and AMP were well separated, with a good linearity within a certain range of concentration; and the recovery rates were within the range of 90%-108%. As compared with model group, the level of ATP was significantly elevated in high-dose treatment group; ADP contents showed an increasing trend and AMP contents showed a decreasing trend, indicating that QS could significantly improve energy metabolism system in myocardium. By using the HPLC, a qualitative and quantitative analysis method was given for the determination of ATP, ADP and AMP contents in myocardium, providing a method for energy metabolism measurement in biological samples.

Correlation Between COPD And Echocardiographic Features With Severity Of Disease.

Background & Objective: Chronic obstructive pulmonary disease (COPD) is the most common cause of secondary pulmonary hypertension (PH). PH secondary to COPD is associated with a worse prognosis of the disease, a low quality of life, as well as with a higher exacerbation frequency, and consequently with an increase in the healthcare cost of COPD patients. Objective is to assess the cardiac changes secondary to COPD by echocardiography and to find out the correlation between echocardiographic findings and severity of COPD, if there is any Methodology: A total 100 of patients of COPD were selected and staged by pulmonary function test (PFT) and evaluated by echocardiography. Results: On echocardiographic evaluation of COPD, 55% cases had normal echocardiographic parameters. Measurable tricuspid regurgitation (TR) was observed in 24/35 cases (67.5%). Pulmonary hypertension (PH), which is defined as systolic pulmonary arterial pressure (sPAP)> 30 mmHg was observed in 15/25 (63%) cases in which prevalence of mild, moderate, and severe PH were 10/17 (58.82%), 3/16 (23.53%), and 3/17 (17.65%), respectively. The frequencies of PH in mild, moderate, severe, and very severe COPD were 16.67%, 54.55%, 60.00%, and 83.33%, respectively. Right atrial pressure was 10 mmHg in 82.5% cases and 15 mmHg in 17.5% cases. Cor pulmonale was observed in 7/17 (41.17%) cases; 7.50% cases had left ventricle (LV) systolic dysfunction and 47.5% cases had evidence of LV diastolic dysfunction defined as A ≥ E (peak mitral flow velocity of the early rapid filling wave (E), peak velocity of the late filling wave caused by atrial contraction (A) on mitral valve tracing) Left ventricle hypertrophy was found in 22.5% cases. Conclusion: Prevalence of PH has a linear relationship with severity of COPD and severe PH is almost associated with cor pulmonale. Echocardiography helps in early detection of cardiac complications in COPD cases giving time for early interventions.

Application of thoracic ultrasonography for acute cor pulmonale patients in acute respiratory distress syndrome / 中华危重病急救医学

Acute respiratory distress syndrome (ARDS) patients experiencing protective mechanical ventilation, is associated with a marked mortality reduction. However, the incidence of acute cor pulmonale (ACP) in ARDS patients has recently been reported to range between 22% and 25%, as well as a trend for higher mortality. Therefore, the mechanical ventilation strategy is proposed, not only based on the protection of the lung, but also focused on the impact on the right ventricle function. Currently, point-of-care ultrasound has been widely practiced in a variety of clinical setting, which plays more and more important role in the early detection and management of ARDS and its complications. A retrospective study concerning the incidence, pathophysiology and risk factors for ACP patients in ARDS was done to analysis the application of lung ultrasound and echocardiography combined with lung ultrasound in clinical hemodynamics monitoring, and so as to optimize the ventilation setting to protect the function of lung and right ventricle. Further exploration of effective improvement of the pulmonary vascular and right ventricle function the goal-directed ultrasound approach, and the diagnosis and treatment flow is expected.

Relationship between inflammation and blood coagulation function for the prognosis in the patients with acute exacerbation of chronic cor pulmonale / 实用医学杂志

Objective To investigate the relationship between inflammation and blood coagulation function in the patients with acute exacerbation of chronic cor pulmonale (AECCP) and discuss the potential mechanism and influence on the patients. Methods The present study was based on 30 healthy controls and 141 cases of AECCP in our hospital from January 2011 to June 2014.Levels of white blood cell (WBC), neutrophil (NEUT), high-sensitivity C-reactive protein (hs-CRP, Complement 3 (C3), prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB) and thrombin time (TT) in the patients were determined. Results Compared with the healthy controls, the patients had higher levels of WBC, NEUT, hs-CRP, PT, APTT, FIB, TT (all P < 0.001) and lower level of C3 (P < 0.001). Significant positive correlations were found between the levels of WBC, NEUT and FIB (r = 0.196 and r = 0.199, both P < 0.05); hs-CRP and APTT, FIB(r = 0.234, P < 0.01 and r = 0.466, P < 0.001); C3 and FIB(r = 0.466, P < 0.001), and significant negative correlations were observed between the levels of C3 and PT, APTT, TT (r=-0.258, P<0.01;r=-0.279, P < 0.01 and r = -0.168, P < 0.05, respectively). Compared with the survival patients, the cases of death had higher levels of WBC and NEUT (both P < 0.01). The area under receiver operating characteristic curve of WBC and NEUT, predicting the prognosis, was 0.666 (95% CI 0.552, 0.780; P < 0.01) and 0.695 (95% CI 0.558, 0.801; P = 0.001) respectively. Conclusions Inflammation and blood coagulation function disorder usually coexist in the patients with AECCP, and are closely associated with the severity. Levels of both WBC and NEUT can be used as prognosis predictors for the patients.