Cor pulmonale
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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


  • 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


  • 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


  • 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


    • 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


    • 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


    • 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