Cor Pulmonale Flashcards
What is cor pulmonale?
Cor pulmonale is characterized by pulmonary hypertension that
progresses to right ventricular hypertrophy, dilation, and
eventual cardiac failure.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 627-628.
What are the treatment options for cor pulmonale?
Hypoxemia worsens pulmonary hypertension and should be
treated both acutely and chronically by the administration of
oxygen. Diuretics and digitalis may be used in episodes of right
ventricular heart failure that don’t respond to correction of
arterial blood gases.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 141-142.
What factors determine the prognosis of cor
pulmonale?
Patients who can maintain a normal PAO2 have a favorable
prognosis. Patients with concomitant hypoxic lung disease
have a 70% mortality rate within five years from the onset of
peripheral edema. Patients who develop cor pulmonale as a
result of an intrinsic pulmonary vascular disease such as
pulmonary fibrosis have an extremely poor prognosis.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 628.
How does the incidence of cor pulmonale in males
compare to that in females?
Cor pulmonale is five times more likely to occur in male patients
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 628.
What are the primary anesthetic management
objectives for the patient with cor pulmonale?
Preoperative goals are centered around hydration, correction of
electrolyte abnormalities, treating bronchospasm, and improving
the clearance of pulmonary secretions. Large doses of opioids
should be avoided intraoperatively as they may increase the
risk of postoperative ventilatory depression. Volatile
anesthetics assist in bronchodilation and positive-pressure
ventilation aids in correcting V/Q mismatching and opening
collapsed alveoli. Regional anesthesia is effective for lower
extremity procedures, but should be avoided if a high level is
required that would impair the accessory muscles of respiration.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 141-142.
How does chronic hypoxemia and hypercarbia result
in cor pulmonale?
Chronic hypoxemia and hypercarbia result in constriction of
pulmonary arterioles and venules. The vasoconstriction in
pulmonary vessels results in pulmonary hypertension. The
pressure in the pulmonary circuit is transmitted to the right
ventricle, resulting in right-sided heart failure.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 141.
What radiographic signs may be seen in patients
with cor pulmonale?
The chest xray often reveals increased width of the right
pulmonary artery and decreased pulmonary vascular markings
in the lung periphery. A late sign of cor pulmonale may be a
decrease in the retrosternal space on the lateral film as right
ventricular enlargement becomes evident.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 141-142.
What ECG changes may be seen in patients with cor
pulmonale?
Right atrial hypertrophy is manifested as peak P waves in leads
II, III, and aVF. Right axis deviation and right bundle branch
block are often present as a result of right ventricular
hypertrophy.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 141-142.
