Cor pulmonale 1
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Cor pulmonale is right heart failure caused by chronic pulmonary hypertension. It is often caused by lung diseases like COPD and asthma, or pulmonary vascular diseases like pulmonary embolism. Symptoms include dyspnea, fatigue and syncope. Signs include elevated jugular venous pressure, heart murmurs, hepatomegaly and edema. Investigations show signs of pulmonary hypertension and right heart strain on tests like chest x-ray and ECG. Management focuses on treating the underlying cause, respiratory failure with oxygen, and cardiac failure with diuretics. The prognosis is generally poor with 50% of patients dying within 5 years.
Cor pulmonale 1
- 2. • Cor pulmonale is right heart failure caused by chronic pulmonary hypertension
- 3. Causes of cor pulmonale • Lung disease Asthma (severe, chronic) COPD Bronchiectasis Pulmonary fibrosis Lung resection
- 4. • Pulmonary vascular disease Pulmonary emboli Pulmonary vasculitis Primary pulmonary hypertension ARDS Sickle-cell disease Parasite infestation
- 5. • Thoracic cage abnormality Kyphosis Scoliosis Thoracoplasty
- 6. • Neuromuscular disease Myasthenia gravis Poliomyelitis Motor neurone disease
- 7. • Hypoventilation Sleep apnoea Enlarged adenoids in children Cerebrovascular disease
- 8. Clinical features • Symptoms include dyspnoea, fatigue, or syncope. Signs: cyanosis; tachycardia; raised JVP with prominent a and v waves; RV heave; loud p2, pansystolic murmur (tricuspid regurgitation); early diastolic Graham Steell murmur; hepatomegaly and oedema.
- 9. Investigations • FBC: Hb and haematocrit ↑(secondary polycythaemia). ABG; hypoxia, with or without hypercapnia. CXR; enlarged right atrium and ventricle, prominent pulmonary arteries. ECG; P pulmonale; right axis deviation; right ventricular hypertrophy/ strain.
- 10. Management • Treat underlying cause – e.g. COPD and pulmonary infections • Treat respiratory failure – in the acute situation give 24% oxygen if PaO2 <8kPa. Monitor ABG and gradually increase oxygen concentration if Pa CO2 is stable. In COPD patients, long-term oxygen therapy (LTOT) for 15h/d increases survival. Patients with chronic hypoxia when clinically stable should be assessed for LTOT.
- 11. • Treat cardiac failure with diuretics such as frusemide (=furosemide, e.g. 40-160mg/24h PO). Monitor U&E and give amiloride or potassium supplements if necessary. Alternative: spironolactone. • Consider vensection if the haematocrit is > 55%. • Consider heart-lung transplantation in young patients. Prognosis Poor 50% die within 5yrs.