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Cuore polmonare



Malattie cardiache e polmonari
Cuore polmonare

Definizione

Con cuore polmonare si denota un quadro di sovraccarico delle cavità cardiache destre, consecutive ad ipertensione polmonare, la cui eziopatogenesi è subordinata ad una patologia primariamente respiratoria​. Si distinguono due forme di cuore polmonare, cuore polmonare acuto e cuore polmonare cronico. Il cuore polmonare acuto è caratterizzato da un allargamento del ventricolo destro, mentre quello cronico da un’ipertrofia del miocardio.

Epidemiologia

Prevalenza negli Stati Uniti 5-10% delle cardiopatie degli adulti causato da bronco-pneumopatia cronica ostruttiva in più del 50% dei casi. E’ più comune negli uomini. 

 

Fattori di rischio

I fattori di rischio principali sono rappresentati dal fumo, dalla predisposizione alla trombosi venosa, da altitudine elevata, da polveri e fumi tossici.



Eziologia

 

Malattie del parenchima polmonare:

  • Cuore polmonare cronico
  • Pneumopatia ostruttiva
  • Pneumopatie  restrittive

Malattie vascolari polmonari:

  • Cuore polmonare acuto
  • Embolia massiva o emboli multipli

Cuore polmonare cronico:

  • Embolie polmonari ripetute
  • Ipertensione polmonare primitiva
  • Vasculite polmonare
  • Vasocostrizione polmonare secondaria da attitudine elevata

Cardiopatie congenite con shunt sinistra-destra:

  • Difetto del setto interatriale
  • Difetto del setto interventricolare
  • Dotto arterioso pervio
  • Malattia veno occlusiva polmonare
  • Particelle provenienti da abuso di droghe per via e.v.; parassiti o tessuto tumorale, che embolizzano nel letto vascolare polmonare
  • Ventilazione meccanica inadeguata
  • Cifoscoliosi
  • Patologie neuromuscolari
  • Obesità marcata
  • Apnea durante il sonno.

 




Sintomi

Segni della pneumopatia causale:

  • Dispnea
  • Cianosi
  • Tosse
  • Espettorazione
  • Ippocratismo digitale
  • Rantoli umidi e sibilanti

Segni di insufficienza cardiaca destra:

  • Turgore venoso
  • Epatomegalia
  • Edema agli arti inferiori
  • Ascite e versamento pleurico in uno stadio avanzato
  • Il polso è rapido e la fibrillazione atriale è frequente; 
  • Si può ascoltare un soffio sistolico da insufficienza tricuspidale o diastolico da insufficienza polmonare.

 

Complicazioni

Lo stato del malato si deteriora in genere sotto l’effetto di infezioni broncopolmonari, che possono rapidamente provocare un’insufficienza respiratoria acuta.

 

Diagnosi

La diagnosi può essere difficoltosa perché in alcuni casi la malattia resta asintomatica per un lungo periodo. Quando la malattia si manifesta i segni e i sintomi possono essere comuni ad altre patologie polmonari e cardiache.

  • Anamnesi ed esame obiettivo per determinare l’eziologia del cuore polmonare.
  • Esami di laboratorio e di imaging appropriati, sulla base dei dati raccolti.
  • Radiografia del torace e TC per valutare la patologia polmonare.
  • Elettrocardiogramma
  • Ecocardiografia
  • Cateterismo cardiaco 

 

 

 

Terapia

 

Approccio terapeutico

Cuore polmonare acuto:

  • Trattamento dell’embolia polmonare
  • Cauta espansione del volume ematico per mantenere la gittata cardiaca
  • Inalazioni di ossigeno al 100%

Cuore polmonare cronico:

  • Trattare la patologia di base

Terapie specifiche

Cuore polmonare acuto

Terapia primaria:

  • dissoluzione del coagulo mediante trombolisi oppure rimozione dell’embolo polmonare mediante embolectomia

Prevenzione secondaria:

  • trattamento anticoagulante 
  • inserimento di un filtro nella vena cava inferiore.

 

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