Patient D., 54 years old, was admitted to the therapeutic department with complaints of shortness of breath at rest, agg

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Patient D., 54 years old, was admitted to the therapeutic
department with complaints of shortness of breath at rest,
aggravated by physical exertion, cough with the separation of scant
purulent sputum, general weakness, swelling on the legs. From the
anamnesis: it is registered for COPD over the past 8 years, this
exarbation over 1.5 months: the cough intensified with the release
of purulent sputum, “wheezing” breathing appeared, swelling on the
legs appeared. Objective examination data: serious condition. The
chest is barrel-shaped. Percussion sound boxed. With auscultation
of the lungs: vesicular breathing, weakened exhalation is
prolonged, dry wheezing in the lower sections. During auscultation
of the heart, systolic murmur is heard along the left edge of the
sternum and an accent of II tone above the pulmonary trunk. Heart
rate - 102 per minute, blood pressure 140/80 mm Hg The lower edge
of the liver protrudes 4 cm from under the costal arch. Saturation
- 89%. Dense swelling of the feet, legs. GBA: red blood cells -
6.0x1011 / l, Hb - 170 g / l, white blood cells - 12.2x109 / l,
stab leukocytes - 10%, ESR - 7 mm / h. ECG: sinus tachycardia S -
type of ECG, high genital P in II, III, avF leads, predominant R in
V1, V2, deep S in the left chest leads. echocardiography: The left
heart is not dilated. The left atrium is 36 mm in diameter, the
left ventricle is 45 mm in diameter. PV of the left ventricle -
42%. The right heart is dilated. The right ventricle is 52 mm in
diameter, the right atrium: horizontally - 51 mm in diameter,
vertically 55 mm in diameter, pulmonary hypertension (systolic
pressure in the pulmonary artery 45 mm Hg). Tasks: 1. List the
syndromes, highlight the leading syndrome. 2. Make a preliminary
diagnosis. 3. What complications of the underlying disease
developed in this patient? 4. Define treatment tactics.