Cor pulmonale

Cor pulmonale

Updated:09/06/2022

© Jun Wang, MD, PhD

 

General features

  • Latin word: Pulmonary heart
  • Alteration in the structure and function of the right ventricle of the heart
  • Caused by a primary disorder of the respiratory system
  • Commonly associated with pulmonary hypertension
  • Commonly chronic and progressive clinical course
  • Acute cor pulmonale may be life threatening

Etiology

Risks

  • Any conditions that may increase pulmonary artery pressure
  • Diseases of the pulmonary parenchyma
    • Chronic obstructive pulmonary disease
  • Disorders of the pulmonary vessels
  • Disorders affecting chest movement
    • Kyphoscoliosis
    • Marked obesity
    • Neuromuscular diseases
  • Disorders inducing pulmonary arterial constriction
    • Metabolic acidosis
    • Hypoxemia

Pathogenesis



Clinical presentations

  • Associated with right heart failure
  • Dyspnea on exertion: Most common
  • Fatigue, lethargy, exertional syncope, anginal chest pain, etc
  • Jugular venous distension, peripheral edema
  • Cardiovascular: Splitting second heart sound, pulmonary area systolic ejection murmur with a sharp ejection click, systolic tricuspid murmur of regurgitation, etc
  • Lung: findings consistent with underlying lung disorder, COPD, etc
  • Abdomen: hepatomegaly, ascites, etc

Key morphological features

  • Chronic: Right ventricular hypertrophy
  • Acute: Right ventricular dilation

Diagnosis

  • Aim to identify underlying etiologies and evaluation complications
  • Radiologic findings: Enlarged right ventricle
  • CT angiography: Pulmonary thromboembolism
  • Doppler echocardiography: Trans tricuspid pressure gradient
  • Ventilation/perfusion: Chronic thromboembolic PE
  • Right heart catheterization
  • Lung biopsy: Useful if interstitial lung disease is suspected

Treatment

  • Treatment of underlying disorders
  • Improving oxygenation and right ventricular function
  • Supportive therapies: Maintain adequate blood pressure
  • Oxygen: Relieve pulmonary vasoconstriction
  • Diuretics: Decrease elevated right ventricular filling volume
  • Prognosis depends on underlying disorders, worse in primary lung diseases, such as COPD

 

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