Cough hemoptysis is deadly!There is a heart problem

*For medical professionals for reading reference

These 7 situations must be understood!

Points of this example

Heart disease is sometimes manifested as respiratory symptoms, such as cough, sputum, hemoptysis, and dyspnea, which can easily lead to misdiagnosis and missed diagnosis. The first symptom of the two -pointed valve closure in this case is to go to the Department of Respiratory Medicine with "cough and blood in the sputum", and finally diagnosed as two -pointed insufficiency.

Lao Liu is 50 years old this year. He likes cigarettes. Like most smokers, he usually coughs and sputum occasionally, but recently in autumn, the weather turns cold, the temperature difference between day and night is large, and the sputum is worse than ever. Blood with blood. At first Lao Liu thought that he was slow and slow, and didn't care too much. As a result, the symptoms of cough and blood in the sputum increased, and the whole mouth was coughing hematopoietic sputum. Symptoms of hemoptysis are very scared for old smokers, worried about lung tumors. So I went to the hospital for a chest CT examination, and the lung tumor was not found.

Examination is not lung cancer, and the stones in the old Liu Xin also put it down. However, CT shows that bilateral pneumonia combined with internal lung hemorrhage still needs further examination, including cardiac color Doppler ultrasound examination. Lao Liu was in trouble, how could he check the heart when he coughing is a lung problem? In fact, in addition to the manifestation of respiratory diseases, cough may also be a clinical symptom of cardiovascular disease.

Cough may be related to which cardiovascular disease

▎ (1) Congenuity

In the pediatric clinic, in many cases, the first clinic of the patients with a picinoid disease will not look at the heart problem, but to look at the cough. Because on the one hand, the child is too young to express the symptoms of heart discomfort, and on the other hand, the heart disease itself is manifested as a recurrent cough, or even pneumonia. Therefore, when a pediatrician diagnose and treat children's upper respiratory tract infection, don't forget to check whether there is a problem with the heart.

病 (2) valve disease

There are 4 valves in the heart of the human body. Among them, the valve is closely related to the pulmonary circulation. When any situation causes the two -pointed mortar lesions, it may cause changes in pulmonary circulation and blood, which causes cough symptoms.

肿 (3) Heart tumor

Cardiac tumors are prone to tumors beating with the heart, entering and leaving the valve mouth. If the valve is affected, it can cause lung blood stasis and thereby coughing symptoms.

▎ (4) Heart failure

The heart failure caused by various causes can occur, sputum, sputum, and even cough pink foam -like sputum. At the same time, it is accompanied by clinical manifestations of heart failure, such as cannot lie flat and bipedia edema.

疾 (5) Enterprise disease

Some patients with pericardium disease may also have cough symptoms.

(6) aortic disease

Chronic aortic fixture aneurysm cause symptoms such as cough and chest tightness due to large compression of lung tissue in tumors. When the mezzanine aneurysm further increases and even has rupture bleeding trend, even hemoptysis may even occur. In this case, if the respiratory doctor did not discover the aortic disease in time, it may even lead to catastrophic consequences.

药 (7) Cough -related cough of cardiovascular drugs

Cardiovascular patients usually use a wide range of drugs, and some cardiovascular drugs may cause cough. The most common is the antihypertensive vascular tension enzyme inhibitor, which can easily cause irritating dry cough at night. Therefore, when receiving a cough patient, you must carefully ask the patient's medication history.

Sure enough, the result of Lao Liu's heart ultrasound was really heart disease, and it was still seriously closed in severe valve. In order to eliminate the doubts of Lao Liu Xin, the doctor performed science.

What is the incomplete of the two -pointed valve

There are four valves in the heart of the human body, and the normally open and close of the valve maintains the direction of the heart physiology in the blood. When a heart valve is closed, it will cause reverse blood flow, and severe cases of blood flow dynamic disorders will occur.

Figure 1 Diagram of the heart and valve

The closure of the valve is not all due to the lesions of the bilateral structural tissue of the two -pointed pointed, which caused the left ventricular contraction process to be completely closed, causing the blood to flow into the left atrium in reverse, so that the left atrium load and the left ventricular relaxation period increased, so as Causes a series of blood mobility changes.

The cause of incomplete valve closure

1. Damage of petal leaves. The immune response caused by rheumatoid heartow disease causes the lobe thickening, adhesion, fusion, or infective endocarditis, which causes the perforation of the lobe. As a result, the physiological form of the lobe is changed, which affects the closure of the valve and causes the closure of incompleteness.

2. The petal ring expands. Any cause caused by increasing the left ventricle or the degeneration of the two -pointed valve ring and the calcification of the valve ring can cause the two -pointed valve loop to expand and cause the two -pointed valve incompleteness.

3. Damaged tendon cable. Congenital tendon cable abnormalities, spontaneous faults, or secondary to infective endocarditis, rheumatism, tendon cable faults can cause incomplete valve closing.

4, the nipple muscle is damaged. Short -term ischemia of the papillary muscle can cause short -term mitral insufficiency; such as acute myocardial infarction causes the nipple muscle ischemia and necrosis, which causes permanent valve incompleteness.

Therefore, when two -pointed valve clinic is incomplete clinically, the patient should be found in combination with the specific condition of the patient. For example, young patients are considered as congenital tendon cable abnormalities, spontaneous breaks or infective endocarditis, and the lobe and tendon cable lesions; older patients consider degenerating changes, rheumatic heart valve disease usually causes two -pointed tip The stenosis of the petal is incomplete.

Clinical symptoms with incomplete valve closure

The clinical manifestations are different according to the degree of mitral insufficiency (light -medium -weight), acute or chronic, cardiac compensation and whether the cardiac compensation is merged. The typical symptoms of incomplete valve closerness are left heart failure and right heart failure manifestation, that is, difficulty breathing, dyspnea at night, large liver bleeding, abdominal effusion, abdominal bloating, lower limb edema, etc. Acute two -pointed valve closure can quickly show symptoms of pulmonary congestion and acute pulmonary edema, such as cough and hemoptysis, dyspnea, in severe cases, and even ECMOs to maintain respiratory cycle stability (see the case of "Zheng Erbai Saying Mind" 12 and case 38 cases 38 To. The chronic valve closing the incomplete compensation period is longer and the symptoms occur late. The clinical symptoms of angina pectoris may occur for patients with ischemia with ischemia with coronary diseases. Chronic mitral valve is light to moderate clinical symptoms for a long time.

In this case, the symptoms of pulmonary edema caused by incomplete valve closing of the valve.

Metal valve closure incomplete complications

one

Arrhythmia (atrial fibrillation)

The chronic valve is incomplete, and a large amount of blood flows to the left room, causing excessive load in the left room and increasing the left room. Some patients can induce atrial fibrillation.

two

Infectious heart enditis

There are long -term unrealized two -pointed valve closing incompleteness, especially due to the two -pointed insufficiency caused by the lobe or tendon cable fracture. When the bacterial lesions occur, it is easy to cause the two -polyetric gathering of bacteria in its own lesions. Formation of bacterial groups leads to infective endometritis, while the latter at the same time aggravate the insufficiency of the valve.

In some patients with incomplete and infectious endocarditis in the partial valve closer, the collapse of the bio -bio -bio -bio -bio -bio -bio -bio -bio -poureded, and the clinical symptoms of corresponding cerebral infarction and peripheral arterial embolism occur (Figure 2 ~ 4).

Figure 2 Cardiac ultrasound shows two -pointed valve (shown in red arrows)

Figure 3 head CT shows a small amount of bleeding on the right cerebral infarction (shown in red arrows)

Figure 4 The lower limb arterial CTA shows the left femoral artery embolism, and the distal end is not visible.

three

Heart failure

Heart failure is the return of all types of heart disease to the end of the end. When the chronic valve is not closed for a long time, the cardiac cavity will be expanded (Figure 5), and further progress will eventually lead to full -hearted expansion, and then heart failure will occur.

Figure 5 Calcode closure of incompetence patients showed an increased heart shadow before surgery, the cardiac ultrasound displayed the left room expansion (77cm), and the left room expanded (78cm).

Four

Lung complications

If patients in this case, the two valve closure is not easy to occur in the lung complications. In severe cases, pulmonary edema, difficulty breathing, and even mechanical ventilation or ECMO treatment (Figure 6)

Figure 6 chest tablets and chest CT display pulmonary edema (shown in red arrows)

Elimal insufficiency check

When the clinical symptoms and signs (the first zone of the heart and the voicing of the shrinkage period) indicate the two -polyester lesions, the heart color Doppler ultrasound mainly evaluates the heart cavity structure and size, the valve conditions and the condition of opening and closing, and the blood flow through the valve condition. The function of heart contraction and diastolic is the most important test of heart valve disease.

ECG is also an important test of evaluation, mainly depending on whether it is merged with arrhythmia. For different causes of two -pointed valve incompleteness, such as two -pointed valve incompleteness caused by infective endocarditis, it is best to take blood culture examination before the use of antibiotics to clarify the type of germs. Another example is the incompleteness of the ischemia of the two -pointed valve, and the coronary movie should be used to evaluate the coronary condition.

Treatment of incomplete valve closure

The treatment of two -pointed insufficiency of the two -pointed valve determines the treatment plan based on the following factors: different causes, the degree of incompleteness (light -medium -severe), acute or chronic, cardiac compensation, and whether to merge other cardiac lesions, etc. Specific treatment plans include conservative treatment, surgery therapy, and recently developed minimally invasive menstrual custody two -polymeter surgery.

For those who have no clinical symptoms or minor clinical symptoms, light to moderate incompleteness, and the heart size changes are not large. Considering follow -up observation to avoid the increasing condition caused by the above complications. For patients with chronic degenerative lesions, choosing drug treatment or surgical treatment or minimally invasive menstrual custody two valve surgery according to the specific condition. For two -polyetitis caused by infective endocarditis, active surgical treatment should be actively surgical. For patients with incomplete and coronary heart disease in ischemic bilateral closure, evaluate whether the heart function can tolerate surgery, and determine whether surgical treatment or drug treatment is determined. Surgical surgical treatment methods include valve repair and valve replacement, and doctors choose according to different diseases.

Summarize

(1) Symptoms of cough may be related to cardiovascular disease;

(2) Various clinical symptoms of two -pointed valve clinical clinical symptoms, and early diagnosis is important;

(3) There are many causes caused by incompleteness of two -pointed valve;

(4) Incorporation of valve closing may cause the whole body complications;

(5) Determine the treatment plan for the incomplete valve closure of the valve according to the specific condition.

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Expert Introduction

Zheng Zhi

Zheng Zhi, a large vascular surgery of Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, deputy chief physician, and a doctor of medical doctors in Frankfurt University, Germany.International Affiliated Member of the American Cardiology (ACC); member of the International Committee of the International Vascular Alliance (IUA) China Branch; Member of the Asian Cardiovascular and Chests Surgery (ASCVTS); Member of the World Chinese Physician Association (WACD); China ResearchMember of the Vascular Medical Professional Committee of the Society of Hospitals; Member of the Chemical Committee of the China Pharmaceutical Education Association; proposed the concept of aortic lowering therapy of the aortic perfidel to the "medical humanistic care" of the aortaThe "medical innovation, humanistic innovation, and popular science innovation" in the emergency treatment of urgency and critical condition published more than 30 medical papers in international journals (SCI) and domestic magazines.The first post: cardiovascular channel in the medical community

Author of this article: Zheng Zhi

Editor in charge: Peng Jianping Peng Sanmei

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