Cor pulmonale


Cor pulmonale

Description, Causes and Risk Factors:

Alternative Name: Right-sided heart failure.

Cor pulmonale is an abnormal condition of the heart, which is marked by swelling of the right ventricle (lower chamber of the heart). This results from hypertension (high blood pressure) of the lung circulation.

Cor pulmonale

The disease mainly affects middle-aged and elderly men more than woman.

Normally, the left side of the heart produces a higher blood pressure in order to pump blood to the body. The right side of the heart pumps blood through the lungs under much lower pressure. Any condition that leads to prolonged high blood pressure in the arteries of the lungs puts a strain on the right side of the heart. When the right ventricle is unable to properly pump against these abnormally high pressures, it is called cor pulmonale.

Almost any chronic lung disease or condition causing prolonged low blood oxygen levels can lead to cor pulmonale. Some of the disease linked to cor pulmonale are cystic fibrosis, myasthenia gravis, heart disease, and pulmonary arteritis. Other causes may include pulmonary diseases and emphysema.

Risk Factors:

    Chronic obstructive pulmonary disease (COPD).

  • Chronic thromboembolic pulmonary disease.

  • Interstitial lung disease.

  • Kyphoscoliosis.

  • Obstructive sleep apnea.

  • Central sleep apnea.

  • Pneumoconiosis.

  • Primary pulmonary hypertension.

  • Pulmonary vascular disease.

  • Secondary pulmonary hypertension.

Symptoms:

Some of the early signs of cor pulmonale include constant cough, difficulty breathing, fatigue and weakness. As the disease progress, breathing difficulties may become more severe.

General symptoms may include:

    Chest discomfort, usually in the front of the chest.

  • Exercise intolerance.

  • Shortness of breath.

  • Swelling of the feet or ankles.

  • Wheezing and coughing.

  • Cyanosis (Bluish color the skin).

  • Abnormal fluid collection in the abdomen.

  • Swollen neck veins.

  • Rapid heartbeat.

  • Weak pulse.

  • Low blood pressure.

Diagnosis:

Differential diagnosis may include:

    Primary pulmonary hypertension.

  • Pulmonary valve stenosis.

  • Congestive cardiac failure due to primary cardiological disease.

  • Congenital right-sided cardiac impairment.

  • Right-sided heart failure due to right-ventricular myocardial infarction.

  • Ventricular septal defect.

The following tests may be helpful in diagnose cor pulmonale:

    Blood antibody tests.

  • Blood test for BNP (brain natriuretic peptide).

  • Measurement of blood oxygen by arterial blood gas (ABG).

  • Thrombophilia screen if suspected chronic venous thromboembolism (proteins C and S, antithrombin III, Factor V Leiden, anticardiolipin antibodies, homocysteine levels).

  • Pulmonary function tests.

Imaging Studies:

    Chest x-ray.Chest x-rays show RV and proximal pulmonary artery enlargement with distal arterial attenuation.

  • CT scan of the chest.

  • Echocardiogram.

  • Echocardiography or radionuclide imaging is done to evaluate LV and RV function; echocardiography can assess RV systolic pressure but is often technically limited by the lung disorder. Right heart catheterization may be required for confirmation.

  • Ventilation and perfusion scan of the lungs (V/Q scan).

Other Tests May Include:

    Lung biopsy (rarely performed).

  • Bronchoscopy.

Treatment:

Three main components of the therapy cor pulmonale should be separated:

    Management of the underlying cause or disease.

  • Management of ventricular failure.

  • Management of pulmonary hypertension.

Treatment tries to increase oxygen, increase exercise tolerance, and correct the defect if possible. Supplemental oxygen may be prescribed to increase the level of oxygen in the blood.

There are many medicines available to treat cor pulmonale.

    Endothelin receptor blocker (Bosentan or sildenafil) may be given by mouth, but its use is not well studied in cor pulmonale.

  • Calcium channel blockers are often used to treat early cases.

  • Prostacyclin may be given through injection or breathing in (inhalation).

  • Blood thinning (anticoagulant) medications may also be prescribed.

Preventive measures may include: Bed rest, low salt diet, a small amount of fluids, diuretics.

Disclaimer: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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