Cor pulmonale

Complication of Pneumoconiosis

Group 12: Gayatri, Aryan, Dileep , Sai Charitha, Nandini, Rohan,

Yogesh, Pradeep
Pneumoconiosis is a lung disease that affects miners,
builders, and other workers who breathe in certain kinds
of dust on the job.

Over time, the dust gathers in your lungs, and you may
find it hard to get enough air.

You may hear other people call pneumoconiosis “black

lung disease” or “popcorn lung.” There’s no cure, but
treatments can make it easier for you to breathe and go
about your regular activities.
Coal mining dust contains variable amounts of
silica in addition to other components. In coal
worker pneumoconiosis, alveolar macrophages
engulf coal dust particles, which results in cell
death and activation of inflammatory and
fibrotic pathways. Effector cells promote
inflammation and fibrosis around the coal dust
particles, leading to the development of coal
macules and nodules, which may be surrounded
by emphysematous destruction of alveoli.
Nodules can coalesce into larger lesions, which is
characteristic of progressive massive fibrosis. The
risk of progressive massive fibrosis increases with
greater exposure to silica. Progressive massive
fibrosis can develop and continue to expand even
after exposure to coal dust has ceased .
Causes
High blood pressure in the arteries of the lungs is called pulmonary
hypertension. It is the most common cause of cor pulmonale.
In people who have pulmonary hypertension, changes in the small blood
vessels inside the lungs can lead to increased blood pressure in the right side
of the heart. This makes it harder for the heart to pump blood to the lungs.
If this high pressure continues, it puts a strain on the right side of the heart.
That strain can cause cor pulmonale.
Lung conditions that cause a low blood oxygen level in the blood over a long time
can also lead to cor pulmonale. Some of these are:

Autoimmune diseases that damage the lungs, such as scleroderma

Chronic obstructive pulmonary disease (COPD)
Chronic blood clots in the lungs
Cystic fibrosis (CF)
Severe bronchiectasis
Scarring of the lung tissue (interstitial lung disease)
Severe curving of the upper part of the spine (kyphoscoliosis)
Obstructive sleep apnea, which causes stops in
breathing because of airway inflammation
Idiopathic (no specific cause) tightening
(constriction) of the blood vessels of the lungs
Severe left-sided heart failure
Symptoms
Shortness of breath (dyspnea) on exertion or lightheadedness during
activity is often the first symptom of cor pulmonale
Over time, symptoms occur with lighter activity or even while you are at
rest. Symptoms you may have are:

Fainting spells during activity

Chest discomfort, usually in the front of the chest
Exertional chest pain
Exertional syncope
Swelling (edema) of the feet or ankles
Symptoms of lung disorders, such as wheezing or coughing or phlegm
production
Bluish lips and fingers (cyanosis)
Fatigue
Lethargy

They also include chronic productive cough, exertional dyspnea, wheezing,

fatigue, weakness, drowsiness, and alterations in level of consciousness.
Dyspnoea
Cough
Chest pain
Hepatomegaly – The liver is enlarged and tender, and hepatojugular reflux is
present. Подпись
Tachypnoea
Edema
The pulse is weak.
Systolic murmur of TR (tricuspid regurgitation)
Diastolic murmur of PR (pulmonary regurgita­tion)
Prominent a and v waves in JVP Right ventricular failure
A gallop rhythm, tricuspid insufficiency, or a right ventricular
heave may be present.
Cyanosis
Right ventricular heave
PUlmonary ejection click
Loud P 2
.S3RV(Right ventricular third heart sound)
Hypoxaemia.
Of 577 patients with pneumoconiosis who died in 1964-1988 cor pulmonale was revealed on
necropsy in 334, i.e. in 57.8%. In 120 it was the cause of death, i.e. in 20.7% (and it remains
the most frequent cause of death). The mean age of the patients who died from cor pulmonale
does not differ significantly from the rest of the group. The prevalence of cor pulmonale in
different forms of pneumoconiosis did not differ significantly. Emphysema of the lungs was
revealed in 71.2% of the patients who died from cor pulmonale. Embolization of the lungs
was not more frequent in those who died with cor pulmonale; ischaemic heart disease was
significantly less frequent in patients with cor pulmonale than in the rest of the group. Death
from cor pulmonale is still the most frequent cause of death among occupational diseases
• Blood Antibody Test – Antinuclear antibody
(ANA) level for collagen vascular disease, anti-
SCL-70 antibodies in scleroderma and
Coagulations studies to evaluate
hypercoagulability states (eg, serum levels of
proteins S and C, antithrombin III, factor V
Leyden, anticardiolipin antibodies,
homocysteine) to detect chronic venous
thromboembolism
Arterial Blood Gas Analysis :
Arterial blood gas measurements may provide
important information about the level of
oxygenation and type of acid- base disorder.

Chest radiograph: Enlargement of the pulmonary

artery and Left ventricle is seen.

Electrocardiogram: Shows features of right

ventricular hypertrophy/enlargement
Doppler Echocardiography It usually demonstrates
signs of chronic right ventricular (RV) pressure
overload and to estimate pulmonary arterial
pressure
Chest CT angiography to rule out pulmonary
thromboembolism
Ventilation/perfusion (V/Q) scanning can be
particularly useful in evaluating patients with cor
pulmonale,
Hematocrit count-It is done for polycythemia,

Serum alphaI-antitrypsin, if deficiency is suspected

Antinuclear antibody (ANA) level for collagen vascular disease, and anti-SCL-70 antibodies in scleroderma

Coagulations studies to evaluate hypercoagulability states (eg, serum levels of proteins S and C, antithrombin III, factor V Leyden,
anticardiolipin antibodies, homocysteine)

Brain Natriuretic Peptide-Brain natriuretic peptide (BNP) is a peptide hormone that is released in response to volume expansion.

ECG-ECG changes can be seen due to Right Ventricle Hypertrophy. ECG changes may include the following:

Right axis deviation

P-pulmonale pattern (an increase in P wave amplitude in leads 2, 3, and aVF)

Low-voltage QRS because of underlying COPD with hyperinflation

2-D and Doppler Echocardiography-

Magnetic Resonance Imaging

Cardiac Catheterization
Ultrafast, ECG-gated CTscanningIt is used to study right
ventricular (RV) function. In addition to estimating RV ejection
fraction (RVEF), this imaging modality can estimate RV wall mass.

Lung Biopsy Itmay occasionally be indicated to determine the

etiology of underlying lung disease. This is especially true if
interstitial lung disease (ILD) is the suspected etiology for
pulmonary hypertension resulting in cor pulmonale.
Treatment

Treatment of Coal Worker Pneumoconiosis

Reduction of further exposure
Supportive treatment
Workers with more advanced coal worker pneumoconiosis, especially those with
progressive massive fibrosis, should be restricted from further exposure. In early
and mild disease, the impacts of job loss should be taken into account when
considering removal from exposure.
Treatment is directed toward the clinical manifestations of coal worker
pneumoconiosis. Treatment is not indicated in early and asymptomatic coal
worker pneumoconiosis. Workers with obstructive lung disease may benefit from
treatment for COPD.
Patients with pulmonary hypertension, hypoxemia, or both are given
supplemental oxygen therapy. Pulmonary rehabilitation can help more severely
affected workers carry out activities of daily living.
Lung transplantation should be considered in patients with progressive
respiratory failure.
Progression is common even after exposure ceases, so monitoring should continue
in former coal miners. Medical surveillance can identify new or progressive
radiologic findings that develop after exposure to coal dust ends.
Smoking cessation and surveillance for tuberculosis are recommended for all
exposed workers. Patients with coal worker pneumoconiosis should stay up to
date with recommended vaccinations, including those against pneumococci,
COVID, and influenza
.Diuretics are used to decrease the elevated right ventricular (RV) filling volume
in patients with chronic cor pulmonale.Anticoagulation and thrombolytic
agents for massive pulmonary embolismCalcium channel blockers: vasodilate
the pulmonary arteriesBeta agonists (epoprostenl, iloprost): bronchodilate.

Phlebotomy: Phlebotomyis indicated in patients with chronic cor pulmonale

and chronic hypoxia causing severe polycythemia, is the process of making a
puncture in a vein, usually in the arm, with a cannula for the purpose of
drawing blood.

Uvulopalatopharyngoplasty

(UPPP) in selected patients with sleep apnea and hypoventilation may relieve
cor pulmonale. It is a surgical procedure or sleep surgery used to remove tissue
and/or remodel tissue in the throat
 Complications
Complications/side effects of the treatment

Complications or side effects of treatments may include:

Treatment
1.Oxygen therapy
Side effect or complication
Headaches; Fatigue; Nosebleeds.
1.Medicines
Side effect or complication
Upset stomach; Weight gain; Mood changes; Headache; Bleeding.
3.Cardiac rehab
Side effect or complication
Injury; Abnormal heart rhythm.
4.Embolectomy
Side effect or complication
Bleeding; Injury; Infection.
5.Lung transplant
Side effect or complication
Bleeding; Infection; Organ rejection.
Risk factors
#The risk factors of cor pulmonale of right heart failure

Cor pulmonale, or right heart failure, can be caused by various risk factors, including:

1. Chronic obstructive pulmonary disease (COPD): Long-term exposure to lung irritants such as cigarette smoke, air pollution, or industrial chemicals can lead to
COPD, which in turn can cause cor pulmonale.

2. Pulmonary hypertension: Increased pressure in the blood vessels of the lungs (pulmonary hypertension) can strain the right side of the heart, leading to cor
pulmonale. This can be caused by conditions such as chronic lung diseases, blood clots in the lungs, or certain heart conditions.

3. Sleep-disordered breathing: Conditions such as obstructive sleep apnea, characterized by repeated episodes of complete or partial airway obstruction during sleep,
can lead to cor pulmonale due to chronic hypoxemia (low blood oxygen levels) and increased pulmonary artery pressure.

4. Lung diseases: Chronic lung diseases other than COPD, such as interstitial lung disease, cystic fibrosis, or pulmonary fibrosis, can also contribute to the development
of cor pulmonale.

5. Connective tissue diseases: Certain autoimmune diseases, such as scleroderma or lupus, can affect the lungs and lead to pulmonary hypertension, increasing the risk
of cor pulmonale.

6. Chronic exposure to high altitudes: Living at high altitudes where there is lower oxygen levels in the air can lead to chronic hypoxemia, which may contribute to the
development of cor pulmonale over time.

7. Obesity: Obesity can lead to respiratory issues such as sleep apnea and hypoventilation syndrome, which can in turn contribute to cor pulmonale.

8. Chronic exposure to certain toxins: Exposure to toxins such as asbestos fibers or silica dust can lead to lung damage and pulmonary hypertension, increasing the risk
of cor pulmonale.

It’s important to note that these risk factors may act independently or in combination to contribute to the development of cor pulmonale, and individuals with these
risk factors should be monitored closely for signs and symptoms of right heart failure.