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Cor Pulmonale. Dr. Gerrard Uy. Definition. Cor Pulmonale pulmonary heart disease dilation and hypertrophy of the right ventricle (RV) in response to diseases of the pulmonary vasculature and/or lung parenchyma.

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cor pulmonale

Cor Pulmonale

Dr. GerrardUy

definition
Definition
  • Cor Pulmonale
    • pulmonary heart disease
    • dilation and hypertrophy of the right ventricle (RV) in response to diseases of the pulmonary vasculature and/or lung parenchyma.
    • excluded congenital heart disease and those diseases in which the right heart fails secondary to dysfunction of the left side of the heart
etiology and epidemiology
Etiology and Epidemiology
  • develops in response to acute or chronic changes in the pulmonary vasculature
  • Changes that are sufficient to cause pulmonary hypertension
  • Once patients with chronic pulmonary or pulmonary vascular disease develop cor pulmonale, their prognosis worsens
pathophysiology
Pathophysiology
  • pulmonary hypertension that is sufficient to lead to RV dilation, with or without the development of concomitant RV hypertrophy
  • Right ventricle: thin walled, compliant
    • Better suited for high volumes than high pressure
  • Sustained pressure overload (pulm HPN) and increased vascular resistance causes RV to fail
pathophysiology1
Pathophysiology
  • Acute Cor Pulmonale
    • occurs after a sudden and severe stimulus with RV dilatation and failure but no RV hypertrophy
      • e.g massive pulmonary embolus
  • Chronic Cor pulmonale
    • more slowly evolving and slowly progressive pulmonary hypertension that leads to RV dilation and hypertrophy
factors that determine severity
Factors that determine severity
  • hypoxia secondary to alterations in gas exchange
  • Hypercapnia
  • Acidosis
  • alterations in RV volume overload that are affected by:
      • exercise, heart rate, polycythemia, or increased salt and retention because of a fall in cardiac output
clinical presentation
Clinical presentation
  • Symptoms:
    • Dyspnea, the most common symptom
        • usually the result of the increased work of breathing secondary to changes in elastic recoil of the lung (fibrosing lung diseases) or altered respiratory mechanics
    • Orthopnea and paroxysmal nocturnal dyspnea are rarely symptoms of isolated right HF
        • reflect the increased work of breathing in the supine position that results from compromised excursion of the diaphragm
clinical presentation1
Clinical presentation
  • Symptoms:
    • Tussive or effort-related syncope
        • because of the inability of the RV to deliver blood adequately to the left side of the heart
    • Abdominal pain and ascites
        • Due to right heart failure
    • Lower extremity edema
        • secondary to neurohormonal activation, elevated RV filling pressures, or increased levels of carbon dioxide and hypoxia,
clinical presentation2
Clinical presentation
  • Signs
    • tachypnea
    • elevated jugular venous pressures
    • hepatomegaly
    • lower-extremity edema
    • Cyanosis is a late finding
diagnosis
Diagnosis
  • ECG
    • P pulmonale, right axis deviation, and RV hypertrophy
  • Chest X Ray
    • enlargement of the main pulmonary artery, hilar vessels, and the descending right pulmonary artery
  • Spiral CT
    • acute thromboembolic disease
diagnosis1
Diagnosis
  • 2D echo
    • measuring RV thickness and chamber dimensions
  • Doppler echocardiography
    • assess pulmonary artery pressures
  • MRI
    • assessing RV structure and function, particularly in patients who are difficult to image with 2-D echocardiography because of severe lung disease
treatment
Treatment
  • Primary goal: target the underlying pulmonary disease
      • decrease in pulmonary vascular resistance and relieve the pressure overload on the RV
  • General principles:
      • decreasing the work of breathing using noninvasive mechanical ventilation, bronchodilation, and steroids
      • treating any underlying infection
    • Adequate oxygenation (oxygen saturation 90–92%) will also decrease pulmonary vascular resistance and reduce the demands on the RV
    • Diuretics
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