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. 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 ( 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 ( III )

Abnormal Respiratory Control Idiopathic hypoventilation Syndrome Obesity hypoventilation syndrome (Pick-Wickian syndrome) Cerebrovascular disease

Hypercapnea

Acidemia A

Hypoxia

Anatomic changes

Pulmonary Vessel Restriction

Increased Viscosity
Acidosis C

Increased C.O.

Chronic Cor Pulmonale Rt. Ventricular Failure

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
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
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
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
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
1960-1970 : 3 yr mortality 50-60% Recent times : 5 - 10 years or more