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Cor Pulmonale. Sung Chul Hwang, M.D. Dept. of Pulmonary and Critical Care Medicine Ajou University School of Medicine. Cor Pulmonale. Right Sided Heart Disease, secondarily caused by abnormalities of lung parenchyme, airways, thorax, or respiratory control mechanisms.

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cor pulmonale

CorPulmonale

Sung Chul Hwang, M.D.

Dept. of Pulmonary and Critical Care Medicine

Ajou University School of Medicine

cor pulmonale2
Cor Pulmonale
  • Right Sided Heart Disease,secondarily caused by abnormalities of lung parenchyme, airways, thorax, or respiratory control mechanisms.
  • Noevidence of other heart conditions,
  • Acute vs. Chronic
etiology of cor pulmonale i
Lung and Airways

COPD

Asthma

Bronchiectasis

DILD

Pulmonary tuberculosis

Vascular Occlusion

Multiple Emboli

Schistosomiasis

Filariasis

Sickle Cell

P. Pulmonary Hypertension

Etiology of Cor Pulmonale ( I )
etiology of cor pulmonale ii
Thoracic Cage

Kyphosis > 100 o

Scoliosis > 120 o

Thoracoplasty

Pleural fibrosis

N-M Disease

Polio Myelitis

Myasthenia Gravis

ALS

Muscular Dystrophy

Etiology of Cor Pulmonale ( II )
etiology of cor pulmonale iii
Etiology of Cor Pulmonale ( III )

Abnormal Respiratory Control

  • Idiopathic hypoventilation Syndrome
  • Obesity hypoventilation syndrome (Pick-Wickian syndrome)
  • Cerebrovascular disease
slide6

Hypercapnea

H

Anatomic changes

Hypoxia

Acidemia

A

Pulmonary Vessel

Restriction

Increased

Viscosity

Increased C.O.

C

Acidosis

Chronic Cor Pulmonale

Rt. Ventricular Failure

pathologic features
Pathologic Features
  • Lung : consistent with Specific diseases
  • Common Features: hypertrophy of microvasculatures
  • Hallmark : Rt. Ventricular Hypertrophy

60g – 200g, > 0.5 CM, RV/LV <2.5

  • Lt. Ventricular Hypertrophy
  • Hypertrophy of Carotid Body
natural history
Natural History
  • Several months to years to develop
  • All ages from child to old people
  • Repeated infections aggravate RV strain into RV failure
  • Initilly respondes well to therapy but progressively becomes refractory
prevalence
Prevalence
  • Emphysema : less frequent
  • Cronic bronchitis : more common
  • US : 6-7 % of Heart failure
  • Delhi : 16%
  • Sheffield in UK : 30 – 40%
  • Autopsy in Chronic Bronchitis : 50%
  • More prevalent in pollution area or smokers
lab findings
Lab. Findings
  • X-Ray : Prominent pulmonary hilum pulmonary artery dilatation

Rt MPA > 20 mm

  • EKG : P- pulmonale, RAD, RVH
  • Echocardiography : RVH, TR, Pulm. Hypertension
  • ABG : Hypoxemia, Hypercapnea, Respiratory acidosis
  • CBC : polycythemia
  • Cardiac catheterization
treatment
Treatment
  • Treat Underlying Disease : COPD Tx, Steroid, Infection control, theophylline, medroxyprogesterone,
  • Continuous O2 : < 2-3L/min
  • Diuretics
  • Phlebotomy
  • Digoxin : controversial
  • Pul. Vasodilators
  • Beta adrenergic agents
  • Reduce Ventilation/Perfusion imbalance : Amitrine bimesylate
prognosis
Prognosis
  • 1960-1970 : 3 yr mortality 50-60%
  • Recent times : 5 - 10 years or more