Cor pulmonale Flashcards
Definiton
altered structure (e.g hypertrophy or dilation) and/or impaired function of the right ventricle that results from pulmonary hypertension. It is associated with diseases of the lung( COPD), vasculature (idiopathic pulmonary arterial hypertension), upper airway (OSA) or chest wall (kyphosis) resulting from diseases affecting the function and/or structure of the lung . Right sided heart disease due to left sided heart disease or congenital heart disease is NOT considered cor pulmonale
Pathophysiology of cor pulmonale
- liver disease causes hypoxia, cyanosis, and sometimes polycythaemia
- hypoxia is sensed both within the kidney and via the carotid body generating increases within the sympathetic activity leads to renal rention of salt and water
- this extra salt and water is mainly held in the capacitance vessels (the large vein) often with a raised JVP
- if vascular permeability rises (particularly when the PaCO2 rises, producing peripheral vasodilation and an increase in capillary pressure), extra fluid accumulates in dependent tissues, mainly the ankles
- A raised JVP and ankle oedema in this setting are NOT due to imapired RV functin, but due to fluid overload and increased vascular permeability
Lung disease that causes corpulmonale
COPD is the major cause of Cor Pulmonale
Cystic fibrosis
ILD
Disorders of the pulmonary circulation that cause cor pulmonale
Primary pulmonary hypertension
Pulmonary thromboembolism
Sickle cell anaemia
Neuromuscular disease that causes cor pulmonale
- Gulliain barre syndrome
- amyotrophic lateral sclerosis
- spinal cord lesions
Thoracic cage disorders that cause cor pulmonale
kyphoscoliosos
2 conditions that cause acute cor pulmonale
- PE or ARDS - result of sudden increase in right ventricular pressure
Symptoms of cor pulmonale
- dyspnoea
- fatigue
- syncope
Signs
- cyanosis
- tachycardia
- raised JVP with prominent A and V waves
- RV heave
- loud P2 pansystolic murmur (tricuspid regurg)
- early diastolic graham steel murmur
JVP signs
- Rise prominent a + V waves
Murmur heard
early diastolic graham steell
CXR signs
- enlarged right atrium and ventricle
- prominent pulmonary arteries
ECG changes
- P Pulmonale
- right axis deviation
- right ventricular hypertrophy
Investigations
- FBC - Hb and haematocrit Increased (secondary polycythaemia)
- ABG: hypoxia, with or without hypercapnia
- CXR: enlarged right atrium and ventricle, prominent pulmonary arteries
- ECG: P pulmonale, right axis deviation, right ventricular hypertrophy.strain
Management
- treat underlying cause- COPD and pulmonary infections
- treat respiratory failure- in the acute situtatuin give 24% oxygen if paO2 <8kPa, monitor ABG and gradually incrrease oxygen concentration if PaCO2 is stable. In COPD patients, LTOT increases survival.
- Treat cardiac failure - with diuretics such as furosemide eg 40-160mg/24h. Monitor U &E and give amiloride or potassium supplements.
- Conisder - venosection if haemotcrit >55%
- consider heart-lung trasnplantation in young patients
