Common Diseases First-Line Drug Strategies

Author: Hongkai Li
Publisher:
Publish Date: 2006-07-01
Features: This book primarily discusses the preferred drugs for the treatment of common diseases. The selection of drugs involves many considerations. First, one must consider the pros and cons of the drug for the human body. Then, identify the response of each individual to the drug, choose the characteristics of different drugs within the same category, and determine the theoretical basis for selecting the preferred drug based on the subjective and objective reasons for the disease's manifestations. This ensures safe, effective, economical, and appropriate treatment, adhering to the principles of scientific, rational, and safe medication. The goal is to alleviate the patient's suffering while minimizing the risks of treatment, reduce the patient's financial burden, and meet the aspirations of physicians and the expectations of patients. It is also the responsibility of healthcare workers. This book can serve as a reference for grassroots healthcare workers and is also suitable for general readers.
7. Chronic Pulmonary Heart Disease
Chronic pulmonary heart disease (CPhD) is a secondary cardiovascular disease caused by chronic lesions in the lungs, chest wall, or pulmonary artery, leading to increased pulmonary circulation resistance and pulmonary artery hypertension. This results in right ventricular hypertrophy and dilation, ultimately causing respiratory failure and heart failure. The prevalence of this disease is higher in high-altitude and cold regions. It is more common in long-term smokers over 40 years old and workers in coal and silica mines.
【Etiology】
Chronic obstructive pulmonary diseases (COPD), such as chronic bronchitis, obstructive pulmonary emphysema, asthma, and cystic fibrosis of the lungs; various diseases that cause pulmonary fibrosis or granuloma formation, such as tuberculosis, pneumoconiosis, diffuse pulmonary interstitial fibrosis, sarcoidosis, radiation pneumonia, and idiopathic pulmonary hemosiderosis; chest movement disorders, such as congenital chest deformities or post-thoracoplasty, pleural fibrosis, and neuromuscular diseases like poliomyelitis and muscular dystrophy; excessive obesity, primary or idiopathic alveolar hypoventilation, and central sleep apnea syndrome can all lead to alveolar ventilation disorders and result in the disease. Additionally, pulmonary vascular diseases, such as primary pulmonary hypertension, nodular pulmonary arteritis, and multiple pulmonary arteriole embolisms, can also trigger this condition.
【Clinical Manifestations】
In the early stage or during functional compensation, patients may only experience chronic cough, sputum production, shortness of breath during exertion, palpitations, decreased labor tolerance, and chest discomfort. Those with pulmonary vascular lesions may also have a sense of chest tightness. Most patients can relieve symptoms after treatment and rest, allowing them to maintain normal work. However, with a long history of repeated episodes, the disease may progress to chronic pulmonary heart disease with cardiopulmonary dysfunction.
In the late stage, due to cardiopulmonary dysfunction, patients, in addition to the aforementioned symptoms, may experience easy fatigue, dyspnea, significant palpitations and shortness of breath during exertion, jugular vein distension leading to cyanosis and edema, inability to lie flat, and even impaired consciousness—symptoms of cardiopulmonary failure. Physical examination of early CPhD patients may reveal signs of the underlying primary disease, such as COPD, tuberculosis, chest or pleural abnormalities, or pulmonary vascular lesions. However, most patients show no other abnormal signs.
After cardiopulmonary dysfunction has worsened, the physical examination may reveal, in addition to primary disease signs, a heaving abdominal palpitation in the xiphoid process due to right ventricular hypertrophy, a third heart sound in the pulmonary valve area, systolic murmurs in the tricuspid valve area, and, in some cases, a third heart sound or gallop rhythm with irregular heart rate. Other signs may include hepatomegaly and pitting edema in the lower limbs.
Chronic pulmonary heart disease has a long course, with the progression from chest, lung, and pulmonary vascular lesions to the development of CPhD taking 3–5 years in some cases, while in others, it may take over a decade. The disease typically progresses slowly in most patients.
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