COR PULMONALE Flashcards
What is cor pulmonale?
right sided heart failure caused by chronic pulmonary arterial hypertension
Outline the pathophysiology of cor pulmonale?
Lung disorder -> poorly ventilated alveoli -> hypoxic pulmonary vasoconstriction to divert blood away from it -> when lots of arterioles vasoconstriction together there’s an increase in resistance = pulmonary hypertension -> makes it hard for the right ventricle to pump blood into the pulmonary circulation
This leads to back pressure of blood in the right atrium, the vena cava and the systemic venous system.
What are the causes of cor pulmonale?
Lung diseases - COPD, bronchiectasis, severe chronic asthma, lung resection, interstitial lung disease, idiopathic pulmonary arterial hypertension, CF
Pulmonary vascular disease - massive PE, pulmonary vasculitis, primary pulmonary hypertension, ARDS, sickle-cell diseases parasite infestation
Thoracic cage abnormality - kyphosis, scoliosis, thoracoplasty
Neuromuscular diseases - myasthenia gravis, poliomyelitis, motor neuron disease
Hypoventilatiobn - sleep apnoea, enlarged adenoids in children
Cerebrovascular disease
How do acute lung disorders e.g. PE cause cor pulmonale?
They causes a rapid rise in pressure in pulmonary system which causes the right ventricle to stretch out (like a water balloon)
How do chronic lung disorders e.g. COPD cause cor pulmonale?
Prolonged high pressures cause the right ventricle to hypertrophy (concentric) so it can contract with more force - this leads to a reduced ventricular chamber space -> diastolic HF
This increase in right ventricular muscle mass means there’s a greater demand for oxygen
The coronaries get squeezed down by the muscle mass so even less blood gets delivered to the ventricle
More demand + less supply = right Ventricular ischaemia
Whats the most common cause of cor pulmonale?
COPD
What are diseases which are NOT considered cor pulmonale?
Left heart dysfunction and failure causing right heart failure
Primary right-sided heart failure
It has to come from the lungs first!!
What are the symptoms of cor pulmonale?
Early presentation is often asymptomatic
Pulmonary hypertension - Severe SOB, fatigue, syncope, chest pain
R sided heart failure - JVP distention, hepatomegaly, oedema
How do you diagnose cor pulmonale?
Echocardiogram shows evidence of increased pressure in pulmonary arteries and right ventricle
Gold standard - right heart catheterisation - measures pulmonary pressures
To look for cause - e.g. spirometry
How do you treat cor pulmonale?
Target underlying lung disease
Supplemental long term oxygen for hypoxia-induced vasoconstriction
Loop diuretic for oedema
Whts the prognosis of cor pulmonale?
Poor unless there is a reversible underlying cause
