PULMONARY INCOMPETENCE
P
PULMONARY HYPERTENSION
In this condition, there is increased resistance to blood flow through the lungs
(blue arrows), usually due to lung disease. The result is a rise in pressure in the
pulmonary artery, the right side of the heart (black lines and arrows), and in the
veins that bring blood to the heart.
Superior vena
Pulmonary
Leftlung
Inferior
vena cava
Right
ventricle
Back pressure
The increased pressure is
transmitted backto veins
throughout the body.
Causes
The most common cause of
increased resistance to blood
flow through the lungs is
constriction ofthe small
arteries in the lungs and
thickening oftheir muscular
walls. This thickening usually
results from a lung disease
such as chronic bronchitis or
emphysema.
p u lm o n a ry in c o m p e te n c e
A r a r e d e f e c t o f t h e p u l m o n a r y
v a lv e
a t
t h e
e x i t
o f t h e
h e a r t ’s
r i g h t
v e n tric le
( l o w e r c h a m b e r ) . T h e v a l v e f a i l s t o c l o s e
p r o p e r l y ,
a l l o w i n g
b l o o d
t o
l e a k
b a c k
i n t o t h e h e a r t . T h e u s u a l c a u s e s o f p u l -
m o n a r y
i n c o m p e t e n c e
a r e
rh e u m a t ic
fe v e r, e n d o c a rd it is
( i n f l a m m a t i o n o f t h e
i n n e r l i n i n g o f t h e h e a r t ) , o r s e v e r e
p u l-
m o n a ry h y p e rt e n s io n .
p u lm o n a ry o e d e m a
A c c u m u l a t i o n
o f
f l u i d
i n
t h e
l u n g s ,
w h i c h i s u s u a l l y d u e t o l e f t - s i d e d
h e a rt
f a ilu r e .T h e
b u i l d - u p o f f l u i d m a y a l s o b e
d u e t o a c h e s t i n f e c t i o n , t o i n h a l a t i o n o f
i r r i t a n t g a s e s , o r t o a n y o f t h e p r o b l e m s
t h a t
c a u s e
g e n e r a l i z e d
o e d e m a
( f l u i d
a c c u m u l a t i o n i n t i s s u e s ) .
T h e
m a i n
s y m p t o m
o f p u l m o n a r y
o e d e m a i s b r e a t h l e s s n e s s , w h i c h i s u s u -
a l l y w o r s e w h e n t h e p e r s o n i s l y i n g f l a t
a n d m a y d i s t u r b s l e e p
( s e e
p a ro x y s m a l
n o c tu rn a l d y s p n o e a ).
T h e r e m a y a l s o b e a
c o u g h
t h a t
p r o d u c e s
f r o t h y
s p u t u m ,
w h i c h i s s o m e t i m e s p i n k c o l o u r e d . I n
s o m e c a s e s b r e a t h i n g m a y s o u n d b u b b l y
o r p o s s i b l y w h e e z y .
A d i a g n o s i s o f p u l m o n a r y o e d e m a i s
m a d e b y a
p h y s ic a l e x a m in a tio n
a n d b y a
c h e s t X -ra y.
T r e a t m e n t
o f t h e
c o n d i t i o n
m a y
i n c l u d e
m o rp h in e ,
d iu re t ic d ru g s ,
a m in o p h y llin e ,
a n d
o x y g e n th e ra p y
; a r t i f i -
c i a l
v e n tila tio n
m a y a l s o b e g i v e n .
p u lm o n a ry s t e n o s is
A
h e a rt
c o n d i t i o n i n w h i c h t h e o u t f l o w
o f b l o o d f r o m t h e r i g h t
v e n tric le
( l o w e r
h e a r t
c h a m b e r )
i s
o b s t r u c t e d ,
c a u s i n g
t h e
h e a r t t o
w o r k h a r d e r i n
o r d e r t o
p u m p b l o o d t o t h e l u n g s .
CAUSES
T h e o b s t r u c t i o n m a y b e c a u s e d b y n a r -
r o w i n g
o f t h e p u l m o n a r y
v a lv e
a t t h e
e x i t o f t h e v e n t r i c l e ;
b y n a r r o w i n g o f
t h e
p u l m o n a r y
a r t e r y ,
w h i c h
c a r r i e s
b l o o d t o t h e l u n g s ; o r b y n a r r o w i n g o f
t h e u p p e r p a r t o f t h e v e n t r i c l e .
SYMPTOMS
P u l m o n a r y s t e n o s i s i s u s u a l l y
c o n g e n ita l,
a n d i t m a y o c c u r o n i t s o w n o r w i t h a
s e t o f h e a r t d e f e c t s t h a t c o l l e c t i v e l y a r e
c a l l e d t h e
te tra lo g y o f F a llo t.
I n r a r e c a s e s ,
t h e s t e n o s i s d e v e l o p s l a t e r i n l i f e , a f t e r
rh e u m a t ic fe v e r,
a n d i t m a y c a u s e s y m p -
t o m s o f h e a r t f a i l u r e .
DIAGNOSIS AND TREATMENT
D i a g n o s i s
o f
p u l m o n a r y
s t e n o s i s
i s
m a d e b y a
c h e s t X - ra y
,
E C G
,
e c h o c a rd io g ra -
p h y ,
a n d
D o p p l e r
u lt ra s o u n d
s c a n n i n g .
A
b a llo o n c a t h e t e r
m a y r e l i e v e t h e n a r -
r o w i n g .
I n
m o r e
s e r i o u s
c a s e s ,
h e a rt-
v a lv e s u r g e r y
o r o t h e r t y p e s o f
o p e n h e a rt
s u r g e r y
a r e o f t e n v e r y s u c c e s s f u l .
p u lp , d e n ta l
T h e s o f t t i s s u e c o n t a i n i n g b l o o d v e s s e l s
a n d n e r v e s t h a t i s s i t u a t e d i n t h e m i d d l e
o f e a c h t o o t h ( s e e
t e e th ).
Enamel
Dentine
Pulp
Gum
Jawbone
Cementum
Nerve and
blood supply
Location of the dental pulp
The pulp is the soft core at the centre of a tooth.
Iftooth decay reaches as far asthe pulp, the latter
degenerates rapidly and must be removed in order
to save the tooth.
p u lp e c to m y
T h e r e m o v a l o f t h e t o o t h
p u lp .
P u l p e c -
t o m y
i s
p a r t
o f t h e
p r o c e d u r e
c a l l e d
ro o t -c a n a l tre a tm e n t.
p u lp it is
I n f l a m m a t i o n o f t h e d e n t a l
p u lp ,
w h i c h
m o s t
c o m
m o n l y o c c u r s
a s a r e s u l t
o f
d e n t a l
c a rie s .
P u l p i t i s c a n l e a d t o p e r i -
a p i c a l
p e rio d o n tit is
a n d a p e r i a p i c a l a b s c e s s
( s e e
a b s c e s s , d e n t a l).
p u lp o to m y
R e m o v a l o f t h e c o r o n a l p a r t o f t h e
p u lp
o f a t o o t h a f t e r i t h a s b e c o m
e i n f l a m e d ,
u s u a l l y
b y
i n f e c t i o n .
I n f e c t i o n
o f t h e
p u l p i s m o s t o f t e n c a u s e d b y e x t e n s i v e
t o o t h
d e c a y
( s e e
c a rie s , d e n ta l)
o r
t o
d e n t a l
f r a c t u r e s
( s e e
fra c tu re , d e n t a l).
N o w , p u l p o t o m y i s p e r f o r m e d o n l y o n
p r i m a r y t e e t h . T h e t e c h n i q u e p r e v e n t s
f u r t h e r d e g e n e r a t i o n o f t h e p u l p .
p u ls e
T h e
r h y t h m i c
e x p a n s i o n
a n d
c o n t r a c -
t i o n
o f a n
a r t e r y
a s
b l o o d
i s
f o r c e d
t h r o u g h i t , p u m p e d b y t h e h e a r t . T h e
p u l s e c a n b e f e l t a t v a r i o u s p o i n t s o n
t h e e x t e r i o r o f t h e b o d y w h e r e a r t e r i e s
l i e j u s t b e l o w t h e s k i n ’s s u r f a c e . E x a m -
p l e s o f s u c h p u l s e p o i n t s a r e t h e i n s i d e
o f t h e w r i s t , t h e s i d e o f t h e n e c k , a n d
t h e t o p o f t h e t h i g h .
p u m p , in fu s io n
A
m
a c h i n e
t h a t
i s
u s e d
i n
o r d e r
t o
a d m i n i s t e r a c o n t i n u o u s a n d c o n t r o l l e d
a m o u n t
o f
a
d r u g
o r
s o m e t i m e s
o f
a n o t h e r f l u i d ( s u c h a s
in s u lin
o r o p i o i d
a n a lg e s ic d r u g s ).
T h e f l u i d i s
d e l i v e r e d
t h r o u g h a n e e d l e t h a t i s i n s e r t e d i n t o a
v e i n o r u n d e r t h e s k i n .
640
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