What is Cor Pulmonale Disease? | Pulmonary Embolism Without Acute Cor Pulmonale

What is Cor Pulmonale Disease?

Cor pulmonale is pulmonary hypertension due to lung disorders, in which the right ventricle of the heart becomes enlarged and thickened, eventually resulting in heart failure.

The heart tries to compensate, resulting in right-sided heart failure. The patient has heart failure due to a primary lung disorder, which causes pulmonary hypertension and enlargement of the right ventricle. Patients will have symptoms of both the underlying pulmonary disease and right-sided heart failure. COPD includes chronic bronchitis and emphysema.

Clinical manifestations of cor pulmonale
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Table of Contents

Causes of cor pulmonale

  • Hypoxic injury.
  • Pulmonary vasoconstriction.
  • Anatomic changes in vascularization.
  • Increased blood viscosity.
  • Idiopathic or primary pulmonary hypertension.
  • HIV infection.
  • Drugs and toxins.
  • And low blood oxygen levels (hypoxia).
  • Left-sided heart failure.
  • Lung disorders can also lead to pulmonary hypertension. 
  • COPD(chronic obstructive pulmonary disease).
  • Low blood oxygen level.
  • Loss of lung tissue from surgery or trauma. 
  • Other causes include heart failure, scleroderma, obesity with reduced ability to breathe.

Signs and symptoms

  • Shortness of breath
  • Chronic wet and productive cough .
  • Swelling of the abdomen with fluid (ascites) .
  • Enlargement or prominent neck and facial veins .
  • Bluish discoloration of the face .
  • Presence of abnormal heart sounds .
  • Cyanosis.
  • Fatigue due to hypoxia and heart failure.
  • Wheezing due to underlying lung condition such as COPD or emphysema.
  • Edema due to right-sided failure; fluid build-up will be independent areas Swelling of the ankles and feet (pedal edema) .
  • Weight gain due to fluid retention.
  • increased heartbeats as attempts to compensate for hypoxia and carry more oxygen .
  • Enlargement of the liver
  • Chest X-Ray
  • ECG
  • Echocardiogram
  • cardiac catheterization
  • artery catheterization.
  • Pulmonary function tests.
  • arterial blood gas.
  • Pulse oximetry. 
  • Increased hemoglobin.

Diagnosing cor pulmonale

Cor pulmonale is diagnosed with both physical and medical exam testing. Your doctor will look for any abnormal heart rhythms and protruding neck veins during a physical exam.

Another testing will also include:

  • CT scans take an image of parts of the body.
  • Chest X-ray takes an image of various past of chest
  • Echocardiogram
  • Lung function test

Treatment

  • Bedrest or decreased activity.
  • Oxygen therapy- 
  • At 2 liters/minute (low flow rate) to help meet the body’s needs.
  • The COPD patient cannot tolerate a high flow of oxygen.
  • Reduce sodium in the diet to reduce fluid retention.
  • Reduce fluid intake to reduce fluid retention.

Medicine and surgery

  • Vasodilators
  • Administer calcium channel blockers to vasodilate: Diltiazem, Nifedipine, Nicardipine, Amlodipine.
  • Administer medications to vasodilate the pulmonary artery: Diazoxide, Hydralazine, Nitroprusside.
  • Administer angiotensin-converting enzyme inhibitor: Captopril, Enalapril.
  • Administer anticoagulant to reduce the risk of clot formation: Heparin.
  • Administer diuretic to remove excess fluid: Furosemide, Bumetanide.
  • Administer cardiac glycoside for symptom relief of heart failure: Digoxin.

       When medical therapy fails, then need to transplant the heart and lungs. 

Complications

  • Back blood flow in the venous system leads to the hepatic vein.
  • The fatty liver produces hepatocytes.
  • Congestive heart failure.
  • Pulmonary edema.

Pulmonary embolism without acute cor pulmonale

Patients with pulmonary embolism or not having heart disease but electrocardiogram changes in acute core pulmonale presented with the prominent S Wave in Lead I, depressed S-T segment, inverted in Lead II, Q wave, and T wave inverted in the lead III.

Conclusion

Cor pulmonale depends on the management of pulmonary hypertension, which can cause difficulty breathing, severe fluid retention, and even shock. It is life-threatening when it’s not treated.

You prevent Cor pulmonale by taking care of the heart and lungs also. Maintain a healthy exercise, weight, and eat a well-balanced diet to heart disease.

Talk with the doctor if you notice any changes in your body, especially if you’re being treated for pulmonary hypertension. Your doctor may need to adjust the treatment plan to help prevent Cor pulmonale.

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