- Pulmonary heart disease (PHD), also known as cor pulmonale, refers to enlarged and failing of the right ventricle of the heart in response to increased pressure in the lungs. - The pathophysiology involves elevated pulmonary vascular resistance which increases pulmonary arterial pressure and right ventricular workload, leading to hypertrophy. - Risk factors include lung diseases, obesity, sleep apnea, altitude and certain drugs. Signs include cyanosis, edema and shortness of breath. Treatment aims to reduce afterload and support the heart.

1. GROUP MEMBERS
• MALIKO MILAMBO. 210300877
• PEGGY RUDO KUREBA. 210300889
• PRECIOUS WAKUMELO. 210302398
• DIANA MULENGA. 210301264
• ESMIE KASALIKA. 210300887
• NTINDA CHISHI. 210301259
• ESNART PHIRI. 210301264

2. INTRODUCTION
• Pulmonary heart disease, also known as cor pulmonale, is the enlargement
and failure of the right ventricle of the heart as a response to increased
vascular resistance (such as from pulmonic stenosis) or high blood
pressure in the lungs. Pulmonary heart disease. Other names. Cor
pulmonale. Right ventricular hypertrophy.

3. OBJECTIVES
GENERAL OBJECTIVE
At the end of the lecture/discussion, students should on
pulmonary heart disease and be able to manage a
patient with this condition.
SPECIFIC OBJECTIVES
At the end of the lecture students should be able to;
• Define pulmonary heart disease.
• State the aetiology of Pulmonary heart disease.

4. CONT’D
• Describe the pathophysiology of Pulmonary heart
disease.
• State the predisposing factors.
• State the clinical manifestations of Pulmonary heart
disease.
• Discuss the management of Pulmonary heart disease.
• State the complications pulmonary heart disease.
• State the preventive measures of Pulmonary heart
disease.

5. • Pulmonary heart disease (PHD) refers to altered structure or function of the
right ventricle occurring in association with abnormal respiratory function.
• Pulmonary heart disease, also known as cor pulmonale, is the enlargement
and failure of the right ventricle of the heart as a response to increased
vascular resistance (such as from pulmonic stenosis) or high blood
pressure.
• Chronic pulmonary heart disease usually results in right ventricular
hypertrophy (RVH), whereas acute pulmonary heart disease usually
results in dilatation. Hypertrophy is an adaptive response to a long-term
increase in pressure.
Definitions

6. THE HEART

8. • The pathophysiology of pulmonary heart disease (cor pulmonale) has always
indicated that an increase in right ventricular afterload causes RV
failure (pulmonary vasoconstriction, anatomic disruption/pulmonary vascular
bed and increased blood viscosity are usually involved), however most of the
time, the right ventricle.
• The initial pathophysiologic event in the production of cor pulmonale is an
elevation of pulmonary vascular resistance. As the resistance increases,
the pulmonary arterial pressure rises, and the right ventricular work increases
leading to right ventricular enlargement (e.g., thickening, dilation, or both).
Pathophysiology

9. • Acute cor pulmonale: pulmonary embolism (more common)
and acute respiratory distress syndrome (ARDS).
• The underlying pathophysiology in a massive pulmonary embolism
causing cor pulmonale is the sudden increase in pulmonary
resistance.
• In ARDS, RV overload can occur due to mechanical ventilation and the
pathologic features of the syndrome itself. Mechanical ventilation,
especially higher tidal volumes, requires a higher transpulmonary
pressure.
CONT’D

10. • In the case of ARDS, cor pulmonale is associated with an increased
possibility of right-to-left shunting through a patent foramen ovale,
which carries a poorer prognosis.
• Several different pathophysiologic mechanisms can lead to pulmonary
hypertension and, subsequently, to cor pulmonale
CONT’D

11. • Obesity and obstructive sleep apnea. In isolation, obesity is not
a risk factor. However, if obesity is combined with obstructive sleep
apnea (meaning that oxygen levels fall while a person is sleeping),
mild PH may occur.
• Gender. Idiopathic PAH and heritable PAH (also known as familial
PAH) are at least two-and-a-half times more common in women than
in men. Females of childbearing age are also more susceptible.
• Pregnancy. Pregnancy is a possible risk factor suggested by
registries and expert opinion. Women who already have PH and
become pregnant have a much higher risk of mortality. Read more
about pregnancy and PH.
Predisposing Factors

12. • Altitude. Living at a high altitude for years can make you more
predisposed to PH. When travelling to high altitudes, your PH
symptoms can be aggravated by the altitude.
• Other diseases. Other diseases, including congenital heart
disease, lung disease, liver disease and connective tissue
disorders like scleroderma and lupus, can lead to the
development of pulmonary hypertension. Read more about PH
and associated diseases.
• Drugs and toxins. Certain drugs, such as methamphetamines
and the diet drug “fen phen,” are known to cause pulmonary
hypertension.
CONT’D

13. • The signs and symptoms of pulmonary hypertension develop slowly. You may
not notice them for months or even years. Symptoms get worse as the disease
progresses.
• Pulmonary hypertension signs and symptoms include:
• Blue lips and skin (cyanosis)
• Chest pressure or pain
• Dizziness or fainting spells (syncope)
• Fast pulse or pounding heartbeat (palpitations)
• Fatigue
• Shortness of breath (dyspnea), initially while exercising and eventually while at
rest
• Swelling (edema) in the ankles, legs and eventually the belly area (abdomen)
Clinical Manifestations

14. • Blood and imaging tests done to help diagnose pulmonary
hypertension may include:
• Blood tests. Blood tests can help determine the cause of
pulmonary hypertension or detect signs of complications.
• Chest X-ray. A chest X-ray creates pictures of the heart, lungs
and chest. A chest X-ray may be used to check for other lung
conditions that can cause pulmonary hypertension.
• Electrocardiogram (ECG). This simple test records the
electrical activity of the heart. It can detect changes in the
heartbeat. Patterns on an ECG may reveal signs of right
ventricle enlargement or strain.
Investigations

15. • Right heart catheterization. If an echocardiogram reveals
pulmonary hypertension, you'll likely have a right heart
catheterization to confirm the diagnosis.
• During this procedure, a cardiologist places a thin, flexible tube
(catheter) into a blood vessel, usually in the groin. The catheter
is gently guided into the right lower heart chamber (right
ventricle) and pulmonary artery. A cardiologist can then
measure blood pressure in the main pulmonary arteries and the
right ventricle.
CONT’D

16. • Oxygen — inhaled by patients via a nasal cannula or face
mask.
• Diuretics — medicine that rids the body of excess fluid that
puts pressure on the heart.
• Calcium channel blockers (CCB) — medicine that helps to
decrease blood pressure.
• Warfarin (Coumadin) — medicine that “thins” blood and
prevents it from clotting.
TREATMENT

17. NURSING CARE
Aims
• To relieve pain
• To promote comfort
• To relieve anxiety
• To reduce and prevent infection

18. ENVIRONMENT
• The patient will be nursed in a paediatric ward on the acute
bay for close observations, and the bed must be railed to
prevent falls.
• The environment should be clean and well ventilated.
• There must be enough light for easy observation.
Resuscitative equipment should be near in case of an
emergency.

19. POSITION
• The patient should be nursed on the cardiac bed in an
upright position to allow full lung expansion.
• Provide support and protection for painful joints e.g.
provide a bed cradle to relieve pressure of linen on the
patient.

20. REST
• Allow bed rest with minimal activity to level of cardiac
activity.
• Minimize noise by putting oil in squeaking trolleys so that
they do not disturb the patient when doing other procedure.
• Do all procedures collectively to avoid further disturbance to
the client.

21. OBSERVATION
• Check temperature to see whether fever is subsiding after
interventions.
• Pulse to monitor cardiac function.
• Respiration to see if dyspnoea has been relieved or not.
Record intake and output to prevent fluid overload.
• Observe for any side effects of drugs to discontinue the drug
if the risk out weighs the benefit

22. PSYCHOLOGICAL CARE
• Explain the disease process to promote understanding and
allay anxiety.
• Allow the patient to verbalise their concerns to gain
cooperation.
• Be available whenever the patient need you so that the
patient can have the feeling of security and develop
confidence in you as a nurse.

23. PSYCHOLOGICAL CARE CONT’
• Every procedure done on the patient should be explained to
the patient to gain cooperation.
• Involve the relatives in the care of the patient so that the
patient can feel the sense of belonging.

24. HYGIENE
• Bed bath should be done in the acute phase to promote
comfort.
• As the condition improves give a bed bath.
• Do oral care to promote apetite, nail care to prevent injuries
when scratching.

25. EXERCISE
• Gradual increase in activity and mobility should be done with
careful observation of the pulse rate and rhythm because
this will tell you how much activity the heart can tolerate.

26. NUTRITION
• The patient should eat a well mixed diet rich in proteins to repair
worn out tissues and also a diet rich in vitamin C to help in healing of
the lesions.
• The diet should also be rich in roughage to prevent constipation
which causes strain on the heart.
• Sodium should be restricted in the diet.

27. ELIMINATION
• Ensure that the patient is opening bowels by providing a bed
pan to facilitate elimination, ensure the patient is passing
urine to rule out renal failure.
• Provide screens for privacy when the patient is using the bed
pan so that they do not retain stool due to embarrassment
because this can lead to constipation.

28. MEDICATION
• Give prescribed drugs and continue to observe for side
effects.

29. INFORMATION EDUCATION AND
COMMUNICATION
• Advice the parents or care taker on the disease process that
is the explaining to them what pulmonary heart disease is,
the cause, risk factors, the signs and symptoms and the
things that can worsen the condition.

30. IEC CONT’
• Advice the patient to avoid activities that can put strain to
the heart.

31. COMPLICATIONS
• Heart failure due to irregular heart action in the form of
arterial fibrillation.
• Infective endocarditis related to valve deformity and
scaring.
• Stroke due to clots forming in the enlarged heart or damaged
valves and cause blockage in blood vessels in the brain.

32. • Right-sided heart enlargement and heart failure (cor pulmonale). In cor
pulmonale, the heart's right lower chamber (ventricle) becomes enlarged. ...
• Blood clots. ...
• Irregular heartbeats (arrhythmias). ...
• Bleeding in the lungs. ...
• Pregnancy complications.
CONT’D

33. • Maintaining a healthy weight range.
• Regularly exercise.
• Eating a healthy and balanced diet
• As well as not smoking.
PREVENTION

34. • In conclusion we learn that high blood pressure in the arteries of the lungs is called
pulmonary hypertension. It is the most common cause of cor pulmonale. In people who
have pulmonary hypertension, changes in the small blood vessels inside the lungs can lead
to increased blood pressure in the right side of the heart.
CONCLUSION

35. REFERENCES
• Robbins, S.L, Kumar, V and Abbas, K (2010).
Pathologic Basis of Disease (8th Edition). W.B
Saunders Company, Philadelphia.
• Clinical paediatrics and child health C Saunders
Elsevier page 180.
• Robbins SL and Kumar V (2007). Basic Pathology (8th
Edition).WB Saunders Co. London.