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
- Trattamento dell’embolia polmonare massiva e degli emboli polmonari multipli.
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.
Ti potrebbero interessare:
- Insufficienza aortica
- Embolia polmonare
- Cardiopatia ischemica
- Polmoniti eosinofile- Malattie polmonari
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