Cor Pulmonale definition, causes, diagnosis and treatment

This is a discussion of Cor Pulmonale regarding its definition, causes, clinical picture, investigations and treatment .

What is meant by Cor Pulmonale ?

 It is a right ventricular hypertrophy due to parenchymal lung disease, vascular lung disease or chest wall disease with or without right sided heart failure. So, there is secondary pulmonary hypertension due to the following causes.

 Causes of Cor Pulmonale ?

1) Parenchymal lung diseases ===>  Hypoxia.
      a. Chronic obstructive pulmonary disease. (chronic bronchitis/emphysema)
      b. Interstitial lung fibrosis
2) Vascular lung diseases      
        a. Bilharzial cor pulmonale
        b. Thromboembolic P++ (subacute cor Pulmonale)
3) Chest wall diseases e.g. Kyphoscliosis===> hypoventilation ===> hypoxia.
4) Disturbance in respiratory control
           • Morbid obesity (pickwickian$)
           • Sleep apnoea.        Both lead to Hypoxia
 Hypoxia ===> pulmonary arteriolar vasoconstriction ===> pulmonary hypertension.

Clinical picture

1) Clinical picture of the Cause
2) Right ventricular++, pulmonary hypertension
3) Right ventricular failure .

Investigations to diagnose Cor Pulmonale

• ECG may be normal with emphysema or there is decreased voltage.
• Echo more accurate to diagnose Rt. V ++ or failure
• Investigation of the cause e.g. lung scan for pulmonary thromboembolism.

Treatment of Cor Pulmonale

• Treatment of the Cause.
• Treatment of right ventricular failure
• Diuretics, vasodilators (ACE inhibitors).
• Aminophylline
• Digitalis (minimal role), you can give small dose as there is +++  incidence of digitalis toxicity.
• O2 therapy e,g, in case of COPD and interstitial pulmonary disease.
• Long term oral therapy with calcium channel blockers with high dose can reduce P++ e.g diltiazem 120-900 mg/dl (systemic hypotension may occur).
• Heart and lung transplantation is recommended for young patients

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