Cor Pulmonale

Definition

Cor pulmonale is an increase in bulk of the right ventricle of the heart, generally caused by chronic diseases or malfunction of the lungs. This condition can lead to heart failure.

Description

Cor pulmonale, or pulmonary heart disease, occurs in 25% of patients with chronic obstructive pulmonary disease (COPD). In fact, about 85% of patients diagnosed with cor pulmonale have COPD. Chronic bronchitis and emphysema are types of COPD. High blood pressure in the blood vessels of the lungs (pulmonary hypertension) causes the enlargement of the right ventricle. In addition to COPD, cor pulmonale may also be caused by lung diseases, such as cystic fibrosis, pulmonary embolism, and pneumoconiosis. Loss of lung tissue after lung surgery or certain chest-wall disturbances can produce cor pulmonale, as can neuromuscular diseases, such as muscular dystrophy. A large pulmonary thromboembolism (blood clot) may lead to acute cor pulmonale.

Causes and symptoms

Any respiratory disease or malfunction that affects the circulatory system of the lungs may lead to cor pulmonale. These circulatory changes cause the right ventricle to compensate for the extra work required to pump blood through the lungs. The right ventricle has thin walls and is crescent-shaped. The resulting pressure causes the right ventricle to dilate and bulge, eventually leading to its failure.

Cor pulmonale should be expected in any patient with COPD and other respiratory or neuromuscular diseases. Initial symptoms of cor pulmonale may actually reflect those of the underlying disease. These may include chronic coughing, wheezing, weakness, fatigue, and shortness of breath. Edema (abnormal buildup of fluid), weakness, and discomfort in the upper chest may be evident in cor pulmonale.

Diagnosis

An electrocardiograph (EKG) will show signs such as frequent premature contractions in the atria or ventricles. Chest x rays may show enlargement of the right descending pulmonary artery. This sign, along with an enlarged main pulmonary artery, indicates pulmonary artery hypertension in patients with COPD. Magnetic resonance imaging (MRI) is often the preferred method of diagnosis for cor pulmonale because it can clearly show and measure volume of the pulmonary arteries. Other tests used to support a diagnosis of cor pulmonale may include arterial blood gas analysis, pulmonary function tests, and hematocrit.

Treatment

Treatment of cor pulmonale is aimed at increasing a patient's exercise tolerance and improving oxygen levels of the arterial blood. Treatment is also aimed at the underlying condition that is producing cor pulmonale. Common treatments include antibiotics for respiratory infection; anticoagulants to reduce the risk of thromboembolism; and digitalis, oxygen, and phlebotomy to reduce red blood cell count. A low-salt diet and restricted fluids are often prescribed.

Alternative treatment

Co-management of the patient with cor pulmonale should be coordinated between the medical doctor and the alternative practitioner. The first step in treatment is to determine the cause of the condition and to evaluate all organ systems of the body. Dietary considerations, for example, a low-salt diet and reduced fluid intake aimed at reducing the edema associated with cor pulmonale, can be supportive aspects of treatment.

Prognosis

The prognosis for cor pulmonale is poor, particularly because it occurs late in the process of serious disease.

Prevention

Cor pulmonale is best prevented by prevention of COPD and other irreversible diseases that lead to heart failure. Smoking cessation is critically important. Carefully following the recommended course of treatment for the underlying disease may help prevent cor pulmonale.

Resources

Organizations

American Heart Association. 7320 Greenville Ave. Dallas, TX 75231. (214) 373-6300. http://www.americanheart.org.

National Heart, Lung and Blood Institute. P.O. Box 30105, Bethesda, MD 20824-0105. (301) 251-1222. http://www.nhlbi.nih.gov.

Key terms

Ventricle — A cavity, as in the brain or heart. The right ventricle of the heart drives blood from the heart into the pulmonary artery, which supplies blood to the lungs.

cor

[kor] (L.)

heart.

cor adipo´sum a heart that has undergone fatty degeneration or that has an accumulation of fat around it.

cor bovi´num a greatly enlarged heart resulting from a hypertrophied left ventricle.

cor pulmona´le a serious cardiac condition in which there is right ventricular heart failure due to pulmonary hypertension secondary to disease of the blood vessels of the lungs. Acute cor pulmonale is an emergency situation arising from a sudden dilatation of the right ventricle as a result of pulmonary embolism. Chronic cor pulmonale develops gradually and is associated with such chronic obstructive pulmonary diseases as emphysema, silicosis, and pulmonary fibrosis following an infection. These conditions impair pulmonary circulation and thus create a “damming” effect on the blood flowing through the pulmonary artery. This in turn slows down the flow of blood from the right ventricle, and the ventricle becomes hypertrophied and dilated.

Signs and symptoms are similar to those of congestive heart failure from other causes: dyspnea, edema of the lower extremities, enlargement of the liver, and distention of neck veins. The hematocrit is increased as the body attempts to compensate for impaired circulation by producing more erythrocytes.

Treatment. Treatment may involve use of drugs to decrease pulmonary vascular resistance, pulmonary embolectomy, or even lung transplantation. More traditional treatments have included administration of bronchodilators and use of a mechanical ventilator to reduce hypoxia and dyspnea. For treatment of the heart failure, see heart failure.

cor pul·mo·na·'le

chronic cor p. is characterized by hypertrophy of the right ventricle resulting from disease of the lungs, except for lung changes in diseases that primarily affect the left side of the heart and pulmonary artery and excluding congenital heart disease; acute cor p. is characterized by dilation and failure of the right side of the heart due to pulmonary embolism. In both types, characteristic electrocardiogram changes occur, and in later stages there is usually right-sided cardiac failure.

Farlex Partner Medical Dictionary © Farlex 2012

cor pulmonale

(kôr′ po͝ol′mə-nä′lē, -năl′ē, pŭl′-)

Acute strain or hypertrophy of the right ventricle caused by a disorder of the lungs or of the pulmonary blood vessels.

cor pulmonale

Cardiology Right ventricular enlargement–ventricular wall ≥ 5 mm or autopsy weight of the right ventricle of > 65 g 2º to pulmonary HTN Etiology 1º lung disease–eg, pulmonary vascular disease, parenchymal defects–eg, emphysema, bronchiectasia, lungs with an abnormal ventilatory drive, and defects in the thoracic cage; in chronic CP, cardiac hypertrophy is combined with dilatation and with time evolves to CHF; in acute CP, there has only been time sufficient for cardiac dilatation; in older Pts, chronic CP is the 3^rd most common cardiac disorder after ASHD and HTN; given its relation to cigarette smoking, CP is more common in ♂ Medical management Supplementary O₂, corticosteroids, anticoagulants, vasodilators, other therapy for underlying lung disease Surgical management Some Pts are candidates for lung and heart-lung transplantation

cor pul·mo·na·le

(kōr pul-mō-nā'lē)

Chronic cor pulmonale is characterized by hypertrophy of the right ventricle resulting from disease of the lungs; acute cor pulmonale is characterized by dilation and failure of the right side of the heart due to pulmonary embolism. In both types, characteristic electrocardiogram changes occur, and in later stages there is usually right-sided cardiac failure.

Medical Dictionary for the Health Professions and Nursing © Farlex 2012

cor pulmonale

A heart disorder caused by a rise in the resistance to the passage of blood through the lungs from conditions such as chronic bronchitis, EMPHYSEMA, SILICOSIS or INTERSTITIAL FIBROSIS. The result is enlargement of the main pumping chamber (ventricle) on the right side and often right HEART FAILURE.

Collins Dictionary of Medicine © Robert M. Youngson 2004, 2005

Mentioned in

References in periodicals archive

Continuous supplemental oxygen therapy is indicated when Pa[O.sub.2] [less than or equal to] 55 mm Hg or Sp[O.sub.2] [less than or equal to] 88% or in presence of cor pulmonale, Pa[O.sub.2] 55-59 mm Hg or Sa[O.sub.2] < 89%, with documented right atrial enlargement, hematocrit > 55%, or congestive heart failure.

Supplemental oxygen utilization during physical therapy interventions

* ECG may be useful in determining the extent of right heart disease (cor pulmonale) due to airway obstruction

Herbal medicine: role in the management of chronic obstructive pulmonary disease (COPD)

These patients all had other abnormalities that could have resulted in the oedema, notably primary salt retention by failing kidneys (creatinine levels 676 [micro]mol/l, 1 276 [micro]mol/l and 168 [micro]mol/l respectively), cor pulmonale and malignant disease.

Mechanisms of oedema formation: the minor role of hypoalbuminaemia

Because a result in this range is only suggestive of CHF, other disorders, such as pulmonary edema, pulmonary embolus, cor pulmonale, and left ventricular dysfunction, should be ruled out (Prahash & Lynch, 2004).

A basic guide to understanding plasma B-type natriuretic peptide in the diagnosis of congestive heart failure

Surgery is required only in severe cases--those that involve the collapse of the glottis on inspiration and the presence of complications of obstruction (e.g., failure to thrive, obstructive sleep apnea, cor pulmonale, severe reflux, or apnea while awake).

Laryngomalacia: an atypical case and review of the literature

Only patients with thoracic apices and curves of 100 degrees or more have an increased risk of death from cor pulmonale and right ventricular failure, Dr.

Late-onset scoliosis prognosis looking better. (Screening Still Needed)

She was dyspneic at rest, had cor pulmonale, was losing weight, dependent on oxygen supplementation, had seen her physician twice in recent months for exacerbations of chronic bronchitis and had one hospital admission for respiratory failure.

Two hospice patients and the roles of the physician and the physician executive. (Hospice Care)

(1-5) Chronic pulmonary complications are thought to be the result of repeated episodes of the acute chest syndrome and include pulmonary fibrosis, pulmonary hypertension (PH), and cor pulmonale. (6-8) Most deaths among SCD patients with chronic lung disease are the result of PH and cor pulmonale.

Pulmonary thrombotic arteriopathy in patients with sickle cell disease

Heart failure caused by pulmonary disease is called cor pulmonale. The most common causes of cor pulmonale are various combinations of emphysema, chronic bronchitis, and/or fibrosis.

THE LUNGS IN HEALTH AND DISEASE

This condition, in which the heart is enlarged because of lung problems, is called cor pulmonale. Patients with cor pulmonale tire easily and have chest pains and palpitations.

Chronic obstructive pulmonary disease