Cor Pulmonale

Cor Pulmonale
Right Sided Heart Disease, secondarily caused by abnormalities of lung parenchyme, airways, thorax, pulmonary circulation or respiratory control mechanisms. or Enlargement of right ventricle No evidence of other heart conditions,

Acute vs. Chronic

 ACUTE COR PULMONALE defined as right heart strain or overload secondary to acute pulmonary hypertension, often due to massive pulmonary embolism. CHRONIC COR PULMONALE is characterized by hypertrophy and dilatation of the right ve ntricle (RV) secondary to the pulmonary hypertension caused by disease of the pulmonary parenchyma and/ or pulmonary vascular system

TYPES

Pulmonary Heart Disease (Cor Pulmonale)

Cor pulmonale is a condition in which the right ventricle of the heart enlarges (with or without right-sided heart failure) as a result of diseases that affect the structure or function of the lung or its vasculature. Any disease affecting the lungs and accompanied by hypoxemia may result in cor pulmonale

Etiology of Cor Pulmonale ( I )

1. Lung and Airways COPD Asthma Bronchiectasis Pulmonary tuberculosis Cystic fibrosis Interstitial lung disease Obstructive sleep apnea Pneumoconiosis

2. Vascular Occlusion Multiple Emboli (PE) Filariasis Sickle Cell, polycythemia vera Pulmonary HTN

Etiology of Cor Pulmonale ( II )

3.Thoracic Cage Kyphosis > 100 o Scoliosis > 120 o Thoracoplasty Pleural fibrosis

4. N-M Disease (Resp muscle weak ness) Polio Myelitis Myasthenia Gravis Muscular Dystrophy

Etiology of Cor Pulmonale ( III )

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

Pathophysiology

Acidemia
A

Hypoxia

-PUL. Endothelial injury

Anatomic changes

-Release of vaso active mediators

Vasoconstriction Pulmonary Vessel Restriction/ PHTN

Rt. Ventricular HYPERTROPHY

Chronic Cor Pulmonale

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
Increased Viscosity

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

Clinical features
Dyspnea Chronic productive cough Wheezing respirations Retrosternal/ substernal pain (be due
to right ventricular ischemia )

Fatigue Fainting spells with activity If CHF

EDEMA NECK VEIN DISTENSION

an enlarged palpable liver, ascites pleural effusion,

Lab. Findings
PE: Abnormal heart sounds: On auscultation of the lungs, wheezes and crackles
RVH is characterized by a left parasternal or subxiphoid heave. Hepatojugular reflux and pulsatile liver are signs of RV failure with systemic venous congestion. hyperresonance of the lungs may be a sign of underlying COPD edema

ABG : Hypoxemia, Hypercapnea, Respiratory acidosis CBC : Hematocrit for polycythemia

 X-Ray : Prominent pulmonary hilum pulmonary artery dilatation + presence of ky

phoscoliosis or hyperinflated lungs.

Rt MPA > 20 mm

EKG : P-pulmonale pattern (an increase in P wave amplitude in leads 2, 3, and aVF) , RVH Cardiac catheterization: measure pulmonary pressure,

 Echocardiography : RVH, TR, Pulm. Hypertension Ventilation/perfusion (V/Q) lung scann ing, pulmonary angiography, and che st computed tomography (CT) scanni ng : to diagnose pulmonary thromboemb
olism as the underlying etiology of cor pul monale

Treatment
Treat Underlying Disease : COPD Tx, Steroid, Infection control, theophylline, CONTINUOUS O2 : < 2-3L/min BRONCHODILATORS: theophyllin : reduce pulmonary vascular resistance and pulmonary arterial pressures acutely in COPD DIURETICS, LOW SODIUM DIET: reduce the workload of heart+ to decrease the elevated right ventricular (RV) filling volume Digoxin : controversial( for CHF)

Anticoagulants: warfarin (at high risk for thromboembolism.)

Tx for Pul.HTN: Pul. Vasodilators,C a channel

SURGERY
PHLEBOTOMY : severe polycythemia, treatment LUNG TRASPLANT