Académique Documents
Professionnel Documents
Culture Documents
Cor Pulmonale
Right Sided Heart Disease, secondarily caused by abnormalities of lung parenchyme, airways, thorax, pulmonary circulation or respiratory control mechanisms. or Enlargement of right ventricle No evidence of other heart conditions,
ACUTE COR PULMONALE defined as right heart strain or overload secondary to acute pulmonary hypertension, often due to massive pulmonary embolism. CHRONIC COR PULMONALE is characterized by hypertrophy and dilatation of the right ve ntricle (RV) secondary to the pulmonary hypertension caused by disease of the pulmonary parenchyma and/ or pulmonary vascular system
TYPES
2. Vascular Occlusion Multiple Emboli (PE) Filariasis Sickle Cell, polycythemia vera Pulmonary HTN
3.Thoracic Cage Kyphosis > 100 o Scoliosis > 120 o Thoracoplasty Pleural fibrosis
4. N-M Disease (Resp muscle weak ness) Polio Myelitis Myasthenia Gravis Muscular Dystrophy
Pathophysiology
Acidemia
A
Hypoxia
Anatomic changes
Pathologic Features
Lung : consistent with Specific diseases Common Features: hypertrophy of microvasculatures Hallmark : Rt. Ventricular Hypertrophy 60g 200g, > 0.5 CM, RV/LV <2.5 Lt. Ventricular Hypertrophy Hypertrophy of Carotid Body
Increased Viscosity
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
Clinical features
Dyspnea Chronic productive cough Wheezing respirations Retrosternal/ substernal pain (be due
to right ventricular ischemia )
Lab. Findings
PE: Abnormal heart sounds: On auscultation of the lungs, wheezes and crackles
RVH is characterized by a left parasternal or subxiphoid heave. Hepatojugular reflux and pulsatile liver are signs of RV failure with systemic venous congestion. hyperresonance of the lungs may be a sign of underlying COPD edema
Rt MPA > 20 mm
EKG : P-pulmonale pattern (an increase in P wave amplitude in leads 2, 3, and aVF) , RVH Cardiac catheterization: measure pulmonary pressure,
Echocardiography : RVH, TR, Pulm. Hypertension Ventilation/perfusion (V/Q) lung scann ing, pulmonary angiography, and che st computed tomography (CT) scanni ng : to diagnose pulmonary thromboemb
olism as the underlying etiology of cor pul monale
Treatment
Treat Underlying Disease : COPD Tx, Steroid, Infection control, theophylline, CONTINUOUS O2 : < 2-3L/min BRONCHODILATORS: theophyllin : reduce pulmonary vascular resistance and pulmonary arterial pressures acutely in COPD DIURETICS, LOW SODIUM DIET: reduce the workload of heart+ to decrease the elevated right ventricular (RV) filling volume Digoxin : controversial( for CHF)
SURGERY
PHLEBOTOMY : severe polycythemia, treatment LUNG TRASPLANT