Cor Pulmonale

Sung Chul Hwang, M.D.

Dept. of Pulmonary and Critical Care
Medicine
Ajou University School of Medicine
Cor Pulmonale
Right Sided Heart Disease, secondarily
caused by abnormalities oI lung
parenchyme, airways, thorax, or
respiratory control mechanisms.
Noevidence oI other heart conditions,
Acute vs. Chronic
tiology of Cor Pulmonale ( I )
Lung and
Airways
COPD
Asthma
Bronchiectasis
DILD
Pulmonary
tuberculosis
Vascular
Occlusion
Multiple mboli
Schistosomiasis
Filariasis
Sickle Cell
P. Pulmonary
Hypertension
%horacic Cage
Kyphosis > 100
o
Scoliosis > 120
o
%horacoplasty
Pleural fibrosis
N-M Disease
Polio Myelitis
Myasthenia
Gravis
ALS
Muscular
Dystrophy
tiology of Cor Pulmonale ( II )
Abnormal Respiratory Control
Idiopathic hypoventilation syndrome
Obesity hypoventilation syndrome
(Pick-Wickian syndrome)
Cerebrovascular disease
tiology of Cor Pulmonale ( III )
Pulmonary Vessel
Restriction
Hypoxia
H
Hypercapnea
A
Acidemia
Anatomic changes
Chronic Cor Pulmonale
Rt. Ventricular Failure
lncreased
\iscosity
Acidosis
Increased C.O.
Pathologic Features
Lung : consistent with Specific diseases
Common Features: hypertrophy of
microvasculatures
Hallmark : Right Ventricular
Hypertrophy
Left Ventricular Hypertrophy
Hypertrophy of Carotid Body
Natural History
Several months to years to develop
All ages from child to old people
Repeated infections aggravate RV strain
into RV failure
Initilly respondes well to therapy but
progressively becomes refractory
Prevalence
mphysema : less frequent
Chronic bronchitis : more common
US : 6-7 of Heart failure
Delhi : 16
Sheffield in UK : 30 - 40
Autopsy in Chronic Bronchitis : 50
More prevalent in pollution area or
smokers
Lab. Findings
X-Ray : Prominent pulmonary hilum
pulmonary artery dilatation
Rt MPA > 20 mm
KG : P- pulmonale, RAD, RVH
chocardiography : RVH, %R, Pulm.
Hypertension
ABG : Hypoxemia, Hypercapnea,
Respiratory acidosis
CBC : polycythemia
Cardiac catheterization
%reatment
%reat Underlying Disease : COPD %x, Steroid,
Infection control, theophylline,
medroxyprogesterone,
Continuous O2 : < 2-3L/min
Diuretics
Phlebotomy
Digoxin : controversial
Pul. Vasodilators
Beta adrenergic agents
Reduce Ventilation/Perfusion imbalance :
Amitrine bimesylate
Prognosis
1960-1970 : 3 yr mortality 50-60
Recent times : 5 - 10 years or more