COR-PULMONALE

DEFINITION
Cor-pulmonale is defined as an alteration in
the structure and function of the right
ventricle (RV) of the heart caused by a
primary disorder of the respiratory system.
 DEFINITION
It is a condition in which the right ventricle of
the heart enlarges (with or without right
sided heart failure) as a result of diseases
that affect the structure or function of the
lung or its vasculature
 SUBTYPES OF COR PULMONALE

Acute Cor Pulmonale

It is the result of a sudden increase in right ventricular pressure, as seen in

massive Pulmonary Embolism or Acute Respiratory Distress

Syndrome(ARDS) giving very little room for compensation.

Chronic Cor Pulmonale

.

  In chronic Cor-pulmonale, an increase of right ventricular occurs

slowly (PAH)
ETIOLOGY
 Conditions that restrict or compromise ventilatory
function
 Deformities of the Thoracic Cage
 Massive Obesity
 COPD ,ARDS
 Myasthenia Gravis, GB Syndrome

 Conditions that reduce the pulmonary vascular bed.

• Pulmonary Arterial Hypertension
 Pulmonary Embolus
PULMONARY HYPERTENSION

 Pulmonary Hypertension is defined as mean

Pulmonary Artery Pressure >20mmHg at rest
or >30 mmHg with exercise.
 CLINICAL MANIFESTATIONS

 Dyspnea, Wheezing, Fatigue

 Chronic productive cough
 Jugular vein distension
 Retrosternal /Anginal pain - or Due to right
ventricular ischemia
 Polycythemia , Chronic Hypoxemia
 Hemoptysis - Due to rupture of a dilated or
atherosclerotic pulmonary arteriole.
 Right upper quadrant abdominal discomfort and
jaundice.
 CLINICAL MANIFESTATIONS

 If heart failure accompanies cor-pulmonale

will have additional manifestations such as
• Peripheral edema
• Weight gain
• Distended neck veins
• Full bounding pulse
• Enlarged liver and Cyanosis
 DIAGNOSTIC EVALUATION

 HISTORY COLLECTION
 PHYSICAL EXAMINATION
 Increase in chest diameter
 Distended neck veins and cyanosis
 On auscultation - wheezes and crackles

 LABORATORY TESTS
 ABG ANALYSIS- Reveals decreased PaO2 & pH and
Increased PaCo2.(Hypercapnia).
 BRAIN NATRIURETIC PEPTIDE (BNP)
 HEMATOCRIT COUNT- It is done for polycythemia
 DIAGNOSTIC EVALUATION
 PULMONARY FUNCTION TEST
 CHEST RADIOGRAPHY
 1. Enlarged pulmonary artery.
 2. Enlarged right ventricle.
 3. Distended neck vein.
 4. Right Ventricle Hypertrophy
 5. Hyperinflation of lungs
 ECHOCARDIOGRAPHY
 RVH
DIAGNOSTIC EVALUATION

 PULMONARY ANGIOGRAPHY
 CT SCANNING
 MRI
 Accurate dimensions of the right ventricle.
 CARDIAC CATHETERIZATION
 Evaluation and diagnosis of pulmonary
hypertension ,RVP
MEDICAL MANAGEMENT
NON-INVASIVE MANAGEMNT
 OXYGEN THERAPY
1. Decreases pulmonary vascular
resistance by diminishing
pulmonary vasoconstriction

2. improves right ventricular stroke

volume and cardiac output

 Non Invasive Positive Pressure

Ventilation (NIPPV)
MEDICAL MANAGEMENT

PHARMACOLOGICAL MANAGEMENT
1. Diuretics
2. Vasodilator drugs
3. Bronchodilators
4. Anticoagulation
5. Thrombolytic therapy
6. Inotropes with vasodilatory properties
PHARMACOLOGICAL MANAGEMENT

 DIURETIC AGENTS -In congestive heart failure

 VASODILATORS - Improve cardiac output

A.NONSPECIFIC VASODILATORS
1. Hydralazine
2. Nitroprusside
3. Calcium channel blockers such as Nifedipine

B.PULMONARY VASODILATORS

 Prostaglandins decrease pulmonary artery pressure and increase right ventricular

ejection fraction and cardiac output.

 Nitric oxide reliably decreases pulmonary vascular resistance

PHARMACOLOGICAL MANAGEMENT

 ANTICOAGULANT
 Warfarin for Cor-Pulmonale in patients at high risk for
thromboembolism

 INOTROPES WITH VASODILATORY PROPERTIES

 Dobutamine is an inotropic agent with vasodilatory effect
which improves right ventricular function and cardiac
output
SURGICAL MANAGEMENT
A. PHLEBOTOMY
B. LUNG TRANSPLANTATION

PHLEBOTOMY
 In patent with pronounced polycythemia (hematocrit >60
% ), phlebotomy may provide symptomatic relief .

 Phlebotomy can mildly decrease the pulmonary artery

pressure and pulmonary vascular resistance .
LUNG TRANSPLANTATION
COMPLICATIONS

 Exertional Syncope
 Hypoxia and significantly limited exercise
tolerance.
 Peripheral Oedema
 Tricuspid Regurgitation
 Hepatic Congestion
 Death
NURSING MANAGEMENT
 NURSING DIAGNOSIS

 Decreased cardiac output related to

restricted cardiac muscle contractility as
evidenced by echocardiographic finding

• Impaired gas exchange related to expiratory

airflow obstruction as evidenced by
decreased oxygen saturation levels
 NURSING DIAGNOSIS

 Impaired tissue perfusion related to

decreased cardiac contractility and expiratory
airflow obstruction as evidenced by increased
capillary refilling time >3 seconds

• Activity intolerance related to decreased

cardiac activity and laboured respirations as
evidenced by difficulty in performing
activities of daily living
 NURSING DIAGNOSIS

 Fatigue related to decreased cardiac activity

and laboured respirations as evidenced by
difficulty in performing activities of daily
living

 Anxiety related to breathlessness as

evidenced by patient`s verbalization and
facial expressions
 NSG INTERVENTIONS
 Determine if the patient has experienced orthopnea, cough,
fatigue, epigastric distress, anorexia, or weight gain or has a
history of previously diagnosed lung disorders.

 Ask if the patient smokes cigarettes, noting the daily

consumption and duration.

 Ask about the color and quantity of the mucus the patient
expectorates.

 Determine the type of dyspnea if it is related only to exertion

or is continuous.
 NSG INTERVENTIONS
 Observe if the patient has difficulty in maintaining breath
while the history is taken.

 Evaluate the rate, type, and quality of respirations.

 Observe the patient for dependent edema from the abdomen

(ascites) and buttocks and down both legs.

 Inspect the patient's chest and thorax for the general

appearance and anteroposterior diameter.

 Look for the use of accessory muscles in breathing.

 NSG INTERVENTIONS

 Educate patient regarding his disease condition.

 Educate patient regarding modification in lifestyle like cessation of

smoking & alcohol consumption.

 Advice patient to reduce spicy & fatty foods.

 Instruct patient to avoid caffeine intake which can increase pulse rate &
produce angina.

 Educate patient to minimize level of activities to prevent strain.

 Advice patient for regular follow-up & care.