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Dr. Gerrard Uy
Definition
Cor Pulmonale
pulmonary heart disease
dilation and hypertrophy of the right ventricle
(RV) in response to diseases of the pulmonary
vasculature and/or lung parenchyma.
excluded congenital heart disease and those
diseases in which the right heart fails
secondary to dysfunction of the left side of
the heart
Pathophysiology
pulmonary hypertension that is sufficient
to lead to RV dilation, with or without the
development of concomitant RV
hypertrophy
Right ventricle: thin walled, compliant
Better suited for high volumes than high
pressure
Pathophysiology
Acute Cor Pulmonale
occurs after a sudden and severe
stimulus with RV dilatation and failure but
no RV hypertrophy
e.g massive pulmonary embolus
Clinical presentation
Symptoms:
Dyspnea, the most common symptom
usually the result of the increased work of breathing
secondary to changes in elastic recoil of the lung
(fibrosing lung diseases) or altered respiratory
mechanics
Clinical presentation
Symptoms:
Tussive or effort-related syncope
because of the inability of the RV to deliver blood
adequately to the left side of the heart
Clinical presentation
Signs
tachypnea
elevated jugular venous pressures
hepatomegaly
lower-extremity edema
Cyanosis is a late finding
Diagnosis
ECG
P pulmonale, right axis deviation, and
RV hypertrophy
Chest X Ray
enlargement of the main pulmonary
artery, hilar vessels, and the descending
right pulmonary artery
Spiral CT
acute thromboembolic disease
Diagnosis
2D echo
measuring RV thickness and chamber
dimensions
Doppler echocardiography
assess pulmonary artery pressures
MRI
assessing RV structure and function,
particularly in patients who are difficult to
image with 2-D echocardiography because of
severe lung disease
Treatment
Primary goal: target the underlying
pulmonary disease
decrease in pulmonary vascular resistance and
relieve the pressure overload on the RV
General principles:
decreasing the work of breathing using noninvasive
mechanical ventilation, bronchodilation, and
steroids
treating any underlying infection