COR PULMONALE

Introduction
as pulmonary arterial hypertension (PAH)
is the sine qua non of cor pulmonale,
we believe that the best definition of cor
pulmonale is :
PAH resulting from diseases affecting
the structure and/or the function of the
lungs;
PAH results in right ventricular
enlargement (hypertrophy and/or

Pulmonary Hypertension (PH)

Haemodynamic & pathophysiological condition
Mean pulmonary arterial pressure (PAP) 25 mmHg at rest as
assessed by right heart catheterization
Can be found in multiple clinical conditions

Cor Pulmonale
Acut
defined as
e
right heart
strain or
overload
secondary to
acute
pulmonary
hypertension,
often due to
massive
pulmonary
embolism.

characterized by
Chron
hypertrophy
&
dilatationic
of the right
ventricle (RV)
secondary to the
pulmonary
hypertension
caused by disease of
the pulmonary
parenchyma &/or
pulmonary vascular
system between the
origins of the main
pulmonary artery
&the entry of the

Etiology Chronic Cor

Respirator
Pulmonale
Restrictive
y

Obstructive
Lung
Disease

COPD* (chronic
obstructive
bronchitis,
emphysema &their
association)
Asthma (with
irreversible airway
obstruction)
Cystic fibrosis
Bronchiectasis
Bronchiolitis
obliterans

Lung
Disease

Neuromuscular diseases:
amyotrophic lateral
sclerosis, myopathy,
bilateral diaphragmatic
paralysis, etc
Kyphoscoliosis
Thoracoplasty
Sequelae of pulmonary
TB
Sarcoidosis
Pneumoconiosis
Drug related lung
diseases
Extrinsic allergic
alveolitis
Connective tissue
diseases

Insufficien
t of central
origin

Central alveolar
hypoventilation
Obesity
hypoventilation
syndrome
(formerly
Pickwickian
syndrome)
Sleep apnoea
syndrome

Pathophysiology
Alveolar Hypoxia
Hypoxic pulmonary
Vasoconstriction
Increased Pulmonary Vascular
Resistance
Pulmonary Hypertention

Hypoxem
ia
Acidemi
a
Capillary
Destruction
(Emphysema)
Polycythe
mia

Increased Right Ventricular

Afterload
Right Ventricular Hypertrophy
Right Ventricular Failure

Cor
Pulmonale

Diagnosis
The clinical exam lacks sensitivity & specificity.
Clinical sign of RHF:
Distended neck veins
Hepatomegaly
Ascites
Peripheral edema
Hyperinflation reduces the yield of cardiac
auscultation for the classic signs of PH & CP
ie, loud P2, S3 gallop, the systolic murmur of
tricuspid regurgitation.

ECG Changes
Right Axis deviation
P Pulmonal
Right Bundle Branch Block

Chest X-Ray

Therapy
Currently there is no specific therapy for PH
associated with COPD or interstitial lung diseases
Long-term O2 administration The treatment
of choice
has been shown partially to reduce the progression of
PH
But, PAP rarely returns to normal values & the structural
abnormalities of pulmonary vessels remain unaltered
oxygen was administered at 1-2 liters/min via nasal, (>
16 hours/day)

 Treatment with conventional

vasodilators is not recommended
may impair gas exchange due to the
inhibition of hypoxic pulmonary
vasoconstriction
lack of efficacy after long-term use.