Pulmonary stenosis Health Dictionary

Narrowing of the AORTIC VALVE in the HEART which obstructs the ?ow of blood through it, with serious effects on the heart and the circulation. The muscle in the left ventricle works harder to compensate for the obstruction and thickens as a result. Stenosis is usually caused by the deposition of calcium on the valve and is commonly associated with ATHEROMA. Untreated, the condition leads to heart failure, but nowadays the stenosis can be treated surgically.... aortic stenosis

Relating to the LUNGS.... pulmonary

The condition in which an embolus (see EMBOLISM), or clot, is lodged in the LUNGS. The source of the clot is usually the veins of the lower abdomen or legs, in which clot formation has occurred as a result of the occurrence of DEEP VEIN THROMBOSIS (DVT) – THROMBOPHLEBITIS (see VEINS, DISEASES OF). Thrombophlebitis, with or without pulmonary embolism, is a not uncommon complication of surgical operations, especially in older patients. This is one reason why nowadays such patients are got up out of bed as quickly as possible, or, alternatively, are encouraged to move and exercise their legs regularly in bed. Long periods of sitting, particularly when travelling, can cause DVT with the risk of pulmonary embolism. The severity of a pulmonary embolism, which is characterised by the sudden onset of pain in the chest, with or without the coughing up of blood, and a varying degree of SHOCK, depends upon the size of the clot. If large enough, it may prove immediately fatal; in other cases, immediate operation may be needed to remove the clot; whilst in less severe cases anticoagulant treatment, in the form of HEPARIN, is given to prevent extension of the clot. For some operations, such as hip-joint replacements, with a high risk of deep-vein thrombosis in the leg, heparin is given for several days postoperatively.... pulmonary embolism

In this condition, increased resistance to the blood ?ow through the LUNGS occurs. This is usually the result of lung disease, and the consequence is an increase in pulmonary artery pressure and in the pressure in the right side of the heart and in the veins bringing blood to the heart. Chronic BRONCHITIS or EMPHYSEMA commonly constrict the small arteries in the lungs, thus causing pulmonary HYPERTENSION. (See also EISENMENGER SYNDROME.)... pulmonary hypertension

Fluid in the small air sacs of the lungs, from inefficient pumping by the heart or leakage of fluid from the blood vessels in the lungs (possibly from envenomation). As it prevents air exchange in the lungs it causes hypoxia and may lead to death.... pulmonary oedema

Narrowing of the PYLORUS, the muscular exit from the STOMACH. It is usually the result of a pyloric ulcer or cancer near the exit of the stomach. Food is delayed when passing from the stomach to the duodenum and vomiting occurs. The stomach may become distended and peristalsis (muscular movement) may be seen through the abdominal wall. Unless surgically treated the patient will steadily deteriorate, losing weight, becoming dehydrated and developing ALKALOSIS.

A related condition, congenital hypertrophic pyloric stenosis, occurs in babies (commonly boys) about 3–5 weeks old, and surgery produces a complete cure.... pyloric stenosis

An unnatural narrowing in any passage or ori?ce of the body. The word is especially used in connection with the four openings of the HEART at which the valves are situated. (See HEART, DISEASES OF.)... stenosis

Tests to assess how the LUNGS are functioning. They range from simple spirometry (measuring breathing capacity) to sophisticated physiological assessments.

Static lung volumes and capacities can be measured: these include vital capacity – the maximum volume of air that can be exhaled slowly and completely after a maximum deep breath; forced vital capacity is a similar manoeuvre using maximal forceful exhalation and can be measured along with expiratory ?ow rates using simple spirometry; total lung capacity is the total volume of air in the chest after a deep breath in; functional residual capacity is the volume of air in the lungs at the end of a normal expiration, with all respiratory muscles relaxed.

Dynamic lung volumes and ?ow rates re?ect the state of the airways. The forced expiratory volume (FEV) is the amount of air forcefully exhaled during the ?rst second after a full breath – it normally accounts for over 75 per cent of the vital capacity. Maximal voluntary ventilation is calculated by asking the patient to breathe as deeply and quickly as possible for 12 seconds; this test can be used to check the internal consistency of other tests and the extent of co-operation by the patient, important when assessing possible neuromuscular weakness affecting respiration. There are several other more sophisticated tests which may not be necessary when assessing most patients. Measurement of arterial blood gases is also an important part of any assessment of lung function.... pulmonary function tests

The normal working of the TRICUSPID VALVE in the HEART is impeded by a narrowing of the opening, often as a sequel of RHEUMATIC FEVER. As with TRICUSPID INCOMPETENCE, heart failure may result and treatment is similar, with surgery to repair or replace the faulty valve an option.... tricuspid stenosis

Narrowing of the opening between the left ATRIUM and left VENTRICLE of the HEART as a result of rigidity of, and adhesion between, the cusps of the MITRAL VALVE. It is due, almost invariably, to the infection RHEUMATIC FEVER. The atrium has to work harder to force blood through the narrowed channel. The effects are similar to those of MITRAL INCOMPETENCE. Shortness of breath and palpitations and irregular beating (?brillation) of the atrium are common consequences in adults. Drug treatment with DIGOXIN and DIURETICS helps, but surgery to dilate or replace the faulty valve may be necessary.... mitral stenosis

A condition which may develop in both LUNGS (interstitial pulmonary ?brosis) or part of one lung. Scarring and thickening of lung tissues occur as a consequence of previous lung in?ammation, which may have been caused by PNEUMONIA or TUBERCULOSIS. Symptoms include cough and breathlessness and diagnosis is con?rmed with a chest X-ray. The patient’s underlying condition should be treated, but the damage already done to lung tissue is usually irreversible. (See also ALVEOLITIS.)... pulmonary fibrosis

See pulmonary disease, chronic obstructive.... chronic obstructive pulmonary disease

A combination of mouth to mouth resuscitation (E.A.R.) to oxygenate the blood, and external chest compression (E.C.C.) to compress the heart to help pump this artificially oxygenated blood around the body to maintain tissue oxygen concentration and prevent death.... cardio-pulmonary resuscitation

Naturally produced in the LUNGS by cells called pneumocytes, this substance is a mixture of phospholipids (see PHOSPHOLIPID) and LIPOPROTEINS. Present in ?uid lining the alveoli (see ALVEOLUS) in the lungs, their action helps maintain their patency. Premature babies may have a de?ciency of surfactant, a disorder which causes severe breathing diffculties – RESPIRATORY DISTRESS SYNDROME or hyaline membrane disease – and HYPOXIA. They will need urgent respiratory support, which includes oxygen and the administration (via an endotracheal tube) of a specially prepared surfactant such as beractant (bovine lung extract) or edfosceril palmitate.... pulmonary surfactant

This is a term encompassing chronic BRONCHITIS, EMPHYSEMA, and chronic ASTHMA where the air?ow into the lungs is obstructed.

Chronic bronchitis is typi?ed by chronic productive cough for at least three months in two successive years (provided other causes such as TUBERCULOSIS, lung cancer and chronic heart failure have been excluded). The characteristics of emphysema are abnormal and permanent enlargement of the airspaces (alveoli) at the furthermost parts of the lung tissue. Rupture of alveoli occurs, resulting in the creation of air spaces with a gradual breakdown in the lung’s ability to oxygenate the blood and remove carbon dioxide from it (see LUNGS). Asthma results in in?ammation of the airways with the lining of the BRONCHIOLES becoming hypersensitive, causing them to constrict. The obstruction may spontaneously improve or do so in response to bronchodilator drugs. If an asthmatic patient’s airway-obstruction is characterised by incomplete reversibility, he or she is deemed to have a form of COPD called asthmatic bronchitis; sufferers from this disorder cannot always be readily distinguished from those people who have chronic bronchitis and/ or emphysema. Symptoms and signs of emphysema, chronic bronchitis and asthmatic bronchitis overlap, making it di?cult sometimes to make a precise diagnosis. Patients with completely reversible air?ow obstruction without the features of chronic bronchitis or emphysema, however, are considered to be suffering from asthma but not from COPD.

The incidence of COPD has been increasing, as has the death rate. In the UK around 30,000 people with COPD die annually and the disorder makes up 10 per cent of all admissions to hospital medical wards, making it a serious cause of illness and disability. The prevalence, incidence and mortality rates increase with age, and more men than women have the disorder, which is also more common in those who are socially disadvantaged.

Causes The most important cause of COPD is cigarette smoking, though only 15 per cent of smokers are likely to develop clinically signi?cant symptoms of the disorder. Smoking is believed to cause persistent airway in?ammation and upset the normal metabolic activity in the lung. Exposure to chemical impurities and dust in the atmosphere may also cause COPD.

Signs and symptoms Most patients develop in?ammation of the airways, excessive growth of mucus-secreting glands in the airways, and changes to other cells in the airways. The result is that mucus is transported less e?ectively along the airways to eventual evacuation as sputum. Small airways become obstructed and the alveoli lose their elasticity. COPD usually starts with repeated attacks of productive cough, commonly following winter colds; these attacks progressively worsen and eventually the patient develops a permanent cough. Recurrent respiratory infections, breathlessness on exertion, wheezing and tightness of the chest follow. Bloodstained and/or infected sputum are also indicative of established disease. Among the symptoms and signs of patients with advanced obstruction of air?ow in the lungs are:

RHONCHI (abnormal musical sounds heard through a STETHOSCOPE when the patient breathes out).

marked indrawing of the muscles between the ribs and development of a barrel-shaped chest.

loss of weight.

CYANOSIS in which the skin develops a blue tinge because of reduced oxygenation of blood in the blood vessels in the skin.

bounding pulse with changes in heart rhythm.

OEDEMA of the legs and arms.

decreasing mobility.

Some patients with COPD have increased ventilation of the alveoli in their lungs, but the levels of oxygen and carbon dioxide are normal so their skin colour is normal. They are, however, breathless so are dubbed ‘pink pu?ers’. Other patients have reduced alveolar ventilation which lowers their oxygen levels causing cyanosis; they also develop COR PULMONALE, a form of heart failure, and become oedematous, so are called ‘blue bloaters’.

Investigations include various tests of lung function, including the patient’s response to bronchodilator drugs. Exercise tests may help, but radiological assessment is not usually of great diagnostic value in the early stages of the disorder.

Treatment depends on how far COPD has progressed. Smoking must be stopped – also an essential preventive step in healthy individuals. Early stages are treated with bronchodilator drugs to relieve breathing symptoms. The next stage is to introduce steroids (given by inhalation). If symptoms worsen, physiotherapy – breathing exercises and postural drainage – is valuable and annual vaccination against INFLUENZA is strongly advised. If the patient develops breathlessness on mild exertion, has cyanosis, wheezing and permanent cough and tends to HYPERVENTILATION, then oxygen therapy should be considered. Antibiotic treatment is necessary if overt infection of the lungs develops.

Complications Sometimes rupture of the pulmonary bullae (thin-walled airspaces produced by the breakdown of the walls of the alveoli) may cause PNEUMOTHORAX and also exert pressure on functioning lung tissue. Respiratory failure and failure of the right side of the heart (which controls blood supply to the lungs), known as cor pulmonale, are late complications in patients whose primary problem is emphysema.

Prognosis This is related to age and to the extent of the patient’s response to bronchodilator drugs. Patients with COPD who develop raised pressure in the heart/lung circulation and subsequent heart failure (cor pulmonale) have a bad prognosis.... chronic obstructive pulmonary disease (copd)

See LUNGS, DISEASES OF.... pulmonary diseases

Cancer of the lung.

By the blood and lymph cancer may be transferred (metastasised) to the lymph nodes under the arm, liver, brain or lungs. An association has been shown between a low intake of Vitamin A and lung cancer. Causes: occupational hazards, environmental pollution, radiation, keeping of pet birds. Cigarette smoking is a strong risk factor. Studies show that a high Vitamin A/carotene intake is protective against the disease in men. Among women, evidence of a similar protective effect has not been found. Vitamin C reduces cancer risk. The increased prevalence of smoking among women results in more female lung cancer. All smokers should drink freely carrot juice (Vitamin A).

Symptoms. Chronic irritative cough, difficult breathing, pain in the chest, recurrent spitting of blood, clubbing of fingers, weight loss.

Alternatives. Only transient benefit is obtainable, yet it may be sufficient to achieve a measure of relief from distressing symptoms. See: CANCER: GENERAL REMARKS. Mullein tea has its supporters. Bugleweed strengthens lung tissue and supports the action of the heart. Blood root is known to arrest bleeding (haemoptysis).

Tea. Equal parts: Red Clover, Gota Kola, Mullein. 2 teaspoons to each cup boiling water; infuse 5-15 minutes. 1 cup three or more times daily.

Formula No 1. Equal parts: Elecampane, Violet, Red Clover, Echinacea. Mix. Dose: Powders: 750mg (three 00 capsules or half a teaspoon). Liquid extracts: 1-2 teaspoons. Tinctures: 1-3 teaspoons. Thrice daily and, if necessary, at bedtime for relief.

Formula No 2. Tincture Blood root 10 drops; Liquid extract Dogwood 20 drops; Liquid extract Elecampane 200 drops (14ml); Liquid extract Bugleweed (Lycopus europ) 30 drops. Flavour with Liquorice if necessary. Dose: 1-2 teaspoons in water 3 or more times daily. (W. Burns-Lingard MNIMH)

Where accompanied by active inflammation, anti-inflammatories are indicated: Mistletoe, Wild Yam, etc.

Diet. A substance in fish oil has been shown to experimentally prevent cancer of the lung. Mackerel, herring and sardines are among fish with the ingredient. See: DIET – CANCER.

Chinese Herbalism. See: CANCER – CHINESE PRESCRIPTION.

Treatment by a general medical practitioner or hospital oncologist. ... cancer – pulmonary

One of a large number of tiny, balloon-like sacs at the end of a bronchiole (one of many small air passages in the lungs) where gases are exchanged during respiration.... alveolus, pulmonary

A tightness of the anus, sometimes referred to as anal stricture.

Anal stenosis prevents the normal passage of faeces, causing constipation and pain during defaecation.

The condition may be present from birth, or may be caused by a number of conditions in which scarring has occurred, such as anal fissure, colitis, or cancer of the anus.

Anal stenosis sometimes occurs after surgery on the anus (for example, to treat haemorrhoids).

The condition is treated by anal dilatation.... anal stenosis

Scarring of lung tissue mainly involving the alveoli. There are a number of causes, including occupational exposure to dusts and fibrosing alveolitis, which is an autoimmune disorder.... interstitial pulmonary fibrosis

A combination of chronic bronchitis and emphysema, in which there is persistent disruption of air flow into or out of the lungs. Patients are sometimes described as either pink puffers or blue bloaters, depending on their condition. Pink puffers maintain adequate oxygen in their bloodstream through an increase in their breathing rate, and remain “pink” despite damage to the lungs. However, they suffer from almost constant shortness of breath. Blue bloaters are cyanotic (have a bluish discoloration of the skin and mucous membranes) because of obesity, and sometimes oedema, mainly due to heart failure resulting from the lung damage.... pulmonary disease, chronic obstructive

A rare defect of the pulmonary valve at the exit of the heart’s right ventricle. The valve fails to close properly, allowing blood to leak back into the heart. The cause is usually rheumatic fever, endocarditis, or severe pulmonary hypertension.... pulmonary incompetence

a congenital abnormality in which the pulmonary veins enter the right atrium or vena cava instead of draining into the left atrium. The clinical features are those of an *atrial septal defect.... anomalous pulmonary venous drainage

(carotid stenosis) narrowing of the carotid artery, which reduces the supply of blood to the brain and is a cause of strokes. It is treated by surgical excision or bypass of the narrowed segment (see also endarterectomy) or by inserting a *stent into the carotid artery.... carotid artery stenosis

the artery that conveys blood from the heart to the lungs for oxygenation: the only artery in the body containing deoxygenated blood. It leaves the right ventricle and passes upwards for 5 cm before dividing into two, one branch going to each lung. Within the lungs each pulmonary artery divides into many fine branches, which end in capillaries in the alveolar walls. See also pulmonary circulation.... pulmonary artery

(PCWP) an indirect measurement of the pressure of blood in the left atrium of the heart, which indicates the adequacy of left heart function. It is measured using a catheter wedged in the most distal segment of the pulmonary artery. See also Swan-Ganz catheter.... pulmonary capillary wedge pressure

a system of blood vessels effecting transport of blood between the heart and lungs. Deoxygenated blood leaves the right ventricle by the pulmonary artery and is carried to the alveolar capillaries of the lungs. Gaseous exchange occurs, with carbon dioxide leaving the circulation and oxygen entering. The oxygenated blood then passes into small veins leading to the pulmonary veins, which leave the lungs and return blood to the left atrium of the heart. The oxygenated blood can then be pumped around the body via the *systemic circulation.... pulmonary circulation

(IPF) a serious interstitial lung disease, formerly called cryptogenic fibrosing alveolitis (see alveolitis). It is characterized by progressive fibrous scarring of the lung and increased numbers of inflammatory cells in the alveoli and surrounding tissues. The disease is usually diagnosed on clinical grounds on a basis of worsening breathlessness, inspiratory crackles at the lung bases on auscultation, clubbing of the fingers or toes, bilateral radiographic shadowing predominantly in the lower zones of the chest X-ray, subpleural *honeycomb change on CT scanning of the chest, and restrictive lung function on spirometry. It is also called usual interstitial pneumonia (UIP; see interstitial pneumonia), a term used by lung pathologists for the most common cellular pattern seen on biopsy. Treatment includes *pirfenidone, corticosteroids, and immunosuppressants.... idiopathic pulmonary fibrosis

leakage of the pulmonary valve in the heart. Mild regurgitation is a common normal finding, but severe congenital pulmonary regurgitation may require surgical correction.... pulmonary regurgitation

see tuberculosis.... pulmonary tuberculosis

a valve in the heart lying between the right ventricle and the pulmonary artery. It is a *semilunar valve that prevents blood returning to the ventricle from the pulmonary artery.... pulmonary valve

a vein carrying oxygenated blood from the lung to the left atrium. See pulmonary circulation.... pulmonary vein