Cor pulmonale

Cor pulmonale is a medical term used to describe a failure of the right side of the heart. It is caused by prolonged high blood pressure in the right ventricle of the heart, which in turn is most often caused by pulmonary hypertension - prolonged high blood pressure in the arteries or veins of the lungs. People with heart disease, or lung diseases such as cystic fibrosis, are at greater risk. more...

Pathophysiology

There are several mechanisms leading to pulmonary hypertension and cor pulmonale:

• Pulmonary vasoconstriction
• Anatomic changes in vascularisation
• Increased blood viscosity
• Primary pulmonary hypertension

Causes

• Acute:
  • Massive pulmonary embolization
  • Exacerbation of chronic cor pulmonale
• Chronic:
  • COPD
  • Loss of lung tissue following trauma or surgery

Treatment

Elimination of the cause is the most important intervention. In pulmonary embolism, thrombolysis (enzymatic dissolution of the blood clot) is advocated if there is dysfunction of the right ventricle. In COPD, long-term oxygen therapy may improve cor pulmonale.

Cor pulmonale may lead to congestive heart failure (CHF), with worsening of respiration due to pulmonary edema, swelling of the legs due to peripheral edema and painful congestive hepatomegaly. This situation requires diuretics (to decrease strain on the heart), sometimes nitrates (to improve blood flow) and occasionally inotropes (to improve heart contractility). CHF is a negative prognostic indicator in cor pulmonale.

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