logging in or signing up COPD - Cor Pulmonale rka10 Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: Embed: Flash iPad Dynamic Copy Does not support media & animations Automatically changes to Flash or non-Flash embed WordPress Embed Customize Embed URL: Copy Thumbnail: Copy The presentation is successfully added In Your Favorites. Views: 886 Category: Entertainment License: All Rights Reserved Like it (0) Dislike it (0) Added: July 05, 2011 This Presentation is Public Favorites: 0 Presentation Description No description available. Comments Posting comment... Premium member Presentation Transcript COPD Cor Pulmonale: COPD Cor PulmonaleCOPD: COPD Disease state characterised by airflow limitation that is not fully reversibleCOPD: COPD Emphysema Chronic Bronchitis Chronic Bronchiolitis / Small Airway DiseaseEMPHYSEMA: EMPHYSEMA Permanent and destructive enlargement of air spaces distal to terminal bronchioles with loss of architecture. Congenital or AcquiredCHRONIC BRONCHITIS: CHRONIC BRONCHITIS Productive cough on most of the days for at least three months over two consecutive years.Risk Factors: Risk Factors Tobacco smoke – 10 pack years Biomass solid fuel fire Occupation–Coal Miners / Cadmium Air Pollution Infections Lung Growth – Infection / Maternal / InuteroSlide 7: 7 Risk Factors for COPD Nutrition Infections Socio-economic status Aging PopulationsHost / Genetic factors: Host / Genetic factors 1 Antitrypsin deficiency Airway hyper-reactivityPathophysiology: Pathophysiology Enlargement of mucus secreting glands number of goblet cells Loss of elastic tissue / inflammation and fibrosis in airway wall / mucus accumulation / enhanced cholinergic tone airflow limitation Decreased pulmonary and chest wall compliancePathophysiology: Pathophysiology Ventilation perfusion mismatch Flattening of diaphragmatic muscles and horizontal alignment of intercostal muscles work of breathing Unopposed action of proteases & antioxidants Alveoli destructionEmphysema Types: Emphysema Types Centriacinar PanacinarClinical Features: Clinical Features Symptoms Cough / Sputum production Dyspnoea Hemoptysis Morning Headache OedemaClinical Features: Clinical Features General Examination Odour of smoke Nicotine staining of finger nails Accessory muscle of respiration Pursed Lip breathing CyanosisClinical Features: Clinical Features General Examination Systemic wasting Signs of RVF Clubbing Body built asthenicClinical Features: Clinical Features “Pink Puffers” – thin, breathless “Blue Blotters” – Oedema, CyanosisClinical Features: Clinical Features Inspection Shape - Barrel shaped Symmetry - Bilaterally Symmetrical Trachea - Central Apex Beat - Not visualized Movements - Decreased BilaterallyClinical Features: Clinical Features Palpation Trachea - Central Apex - Not Palpable Movements - Decreased bilaterally Measurement - AP / TD Chest ExpansionClinical Features: Clinical Features Percussion Hyper resonant Cardiac dullness obliterated Liver dullness – pushed downClinical Features: Clinical Features Auscultation Intensity of breath sounds decreased bilaterally NVBS with prolonged expiration Rhonchi / CrepitationsInvestigations: Investigations Chest X-Ray PA View Hyperlucent lung fields Wide intercostal spaces Horizontally placed ribs Low set diaphragm Tubular Heart BullaeInvestigations: Investigations Polycythemia PFT FEV 1 < 80% FEV 1 / FVC < 70% Exercise tests ABG CT ScanSlide 26: 26 A clinical diagnosis of COPD should be considered in any patient who has dyspnea, chronic cough or sputum production, and/or a history of exposure to risk factors for the disease. Confirmed by spirometry. A post-bronchodilator FEV 1 /FVC < 0.70 confirms Airflow limitation that is not fully reversible. Comorbidities are common in COPD and should be actively identified.Slide 27: SYMPTOMS Cough Sputum Shortness of breath EXPOSURE TO RISK FACTORS Tobacco Occupation Indoor / outdoor pollution SPIROMETRY Diagnosis of COPD èManagement: Management Smoking Cessation Oxygen Therapy Lung Volume reduction surgeryManagement: Management Smoking Cessation Bronchodilators 2 agonist Anticholinergic Theophylline preparationsManagement: Management Corticosteroids Inhaled Oral Parentral Oxygen TherapyOxygen Therapy: Oxygen TherapySurgical Intervention: Surgical Intervention Giant Bullous Disease Consider bullectomy if bullae compress smoking normal lung tissue Lung Volume Reduction Surgery Lung TransplantationManagement: Management Vaccination Influenzae Pneumococcal Mucolytic therapy AcetylcysteineSlide 34: COPD Exacerbation Bacterial Infection 50% Viral Infection 25% Air Pollution 5% Unknown 20% Exacerbation Acute Inflammation Pathophysiology - Current Hypothesis Chronic InflammationAcute Exacerbation of COPD: Acute Exacerbation of COPD Oxygen therapy Bronchodilators 2 agonists / Ipratropium Bromide Corticosteroids Parentral / oral Antibiotics NIVSlide 36: It is not enough for the physician to do what is necessary, but the patient and the attendants must do their part as well and circumstances must be favorable. HippocratesCor Pulmonale: Cor Pulmonale Dilation and Hypertrophy of RV in response to disease of pulmonary vasculature and or lung parenchymaCor Pulmonale: Cor Pulmonale Acute ChronicEtiology: Etiology Chronic Bronchitis COPD ILD Pneumoconiosis Sarcoidosis Bronchiectasis Hypoventilation Syndromes / Cystic FibrosisPathophysiology: Pathophysiology Pulmonary Hypertension Hypoxic Vasoconstriction Acidemia Hypercapnia Lung destruction and fibrosisSymptoms: Symptoms Underlying lung disorder Dyspnoea, Fatigue,. Angina Tussive / effort related syncope RVFSigns: Signs Pulmonary Hypertension Visible & palpable pulmonary artery pulsations Left 2 nd ICS – dull on percussion Loud P 2 Systolic pulmonary ejection click Pulmonary ESM Graham Steel Murmur Prominent a-waves in JVPSigns: Signs RVH Parasternal heave RV pulsation in epigastrium TR (Carvallo’s sign) Cyanosis - Late findingInvestigations: Investigations ECG P Pulmonale RAD RVH ECHO – RV / Pulmonary / Tricuspid valve / Pulmonary ArteryInvestigations: Investigations X-Ray Enlargement of main pulmonary artery CT scan (VP Scan)Treatment: Treatment Treat underlying condition Bronchodilators Steroids NIV Oxygen TherapyTreatment: Treatment RV Failure Diuretics DigoxinTreatment: Treatment PAH Avoid Physical stress Calcium Channel Blockers Endothelial receptor antagonists – Bosentan Phosphodiesterase – 5 inhibitors – Sildenafil ProstacyclinsSlide 49: WORLD COPD DAY November 14 Raising COPD Awareness Worldwide You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.