Cor Pulmonale

Sung Chul Hwang, M.D.

Dept. of Pulmonary and Critical Care
Medicine
Ajou University School of Medicine
 Cor Pulmonale

• Right Sided Heart Disease, secondarily

caused by abnormalities of lung paren
chyme, airways, thorax, or respiratory
control mechanisms.
• Noevidence of other heart conditions,
• Acute vs. Chronic
Etiology of Cor Pulmonale ( I )
Lung and Airwa Vascular Occlusi
ys on
• COPD • Multiple Emboli
• Asthma • Schistosomiasis
• Bronchiectasis • Filariasis
• DILD • Sickle Cell
• Pulmonary tube • P. Pulmonary H
rculosis
ypertension
Etiology of Cor Pulmonale ( II )
N-M Disease
Thoracic Cage
•• Polio Myelitis
Kyphosis > 100 o
•• Myasthenia Gravis
Scoliosis > 120 o
•• ALS
Thoracoplasty
• Muscular Dystrophy
• Pleural fibrosis
 Etiology of Cor Pulmonale ( III )
Abnormal Respiratory Control
• Idiopathic hypoventilation Syndrom
e
• Obesity hypoventilation syndrome (P
ick-Wickian syndrome)
• Cerebrovascular disease
Hypercapnea
H
Hypoxia Anatomic changes
Acidemia
A

Pulmonary Vessel
Restriction
Increased
Viscosity Increased C.O.
Acidosis C

Chronic Cor Pulmonale

Rt. Ventricular Failure

 Pathologic Features
• Lung : consistent with Specific diseases
• Common Features: hypertrophy of micro
vasculatures
• Hallmark : Rt. Ventricular Hypertrophy
60g – 200g, > 0.5 CM, RV/LV <2.5
• Lt. Ventricular Hypertrophy
• Hypertrophy of Carotid Body
 Natural History
• Several months to years to develop
• All ages from child to old people
• Repeated infections aggravate RV strain i
nto RV failure
• Initilly respondes well to therapy but pro
gressively becomes refractory
 Prevalence
• Emphysema : less frequent
• Cronic bronchitis : more common
• US : 6-7 % of Heart failure
• Delhi : 16%
• Sheffield in UK : 30 – 40%
• Autopsy in Chronic Bronchitis : 50%
• More prevalent in pollution area or smok
ers
 Lab. Findings
• X-Ray : Prominent pulmonary hilum
pulmonary artery dilatation
Rt MPA > 20 mm
• EKG : P- pulmonale, RAD, RVH
• Echocardiography : RVH, TR, Pulm. Hy
pertension
• ABG : Hypoxemia, Hypercapnea, Respir
atory acidosis
• CBC : polycythemia
• Cardiac catheterization
 Treatment
• Treat Underlying Disease : COPD Tx, Steroid, I
nfection control, theophylline, medroxyprogeste
rone,
• Continuous O2 : < 2-3L/min
• Diuretics
• Phlebotomy
• Digoxin : controversial
• Pul. Vasodilators
• Beta adrenergic agents
• Reduce Ventilation/Perfusion imbalance : Amit
rine bimesylate
 Prognosis
• 1960-1970 : 3 yr mortality 50-60%

• Recent times : 5 - 10 years or more