Cor Pulmonale

1
Cor Pulmonale

• Sung Chul Hwang, M.D.
• Dept. of Pulmonary and Critical Care Medicine
• Ajou University School of Medicine

2
Cor Pulmonale

• Right Sided Heart Disease, secondarily caused by
  abnormalities of lung parenchyme, airways,
  thorax, or respiratory control mechanisms.
• Noevidence of other heart conditions,
• Acute vs. Chronic

3
Etiology of Cor Pulmonale ( I )

• Vascular Occlusion
• Multiple Emboli
• Schistosomiasis
• Filariasis
• Sickle Cell
• P. Pulmonary Hypertension

• Lung and Airways
• COPD
• Asthma
• Bronchiectasis
• DILD
• Pulmonary tuberculosis

4
Etiology of Cor Pulmonale ( II )

• Thoracic Cage
• Kyphosis gt 100 o
• Scoliosis gt 120 o
• Thoracoplasty
• Pleural fibrosis

• N-M Disease
• Polio Myelitis
• Myasthenia Gravis
• ALS
• Muscular Dystrophy

5
Etiology of Cor Pulmonale ( III )

• Abnormal Respiratory Control
• Idiopathic hypoventilation Syndrome
• Obesity hypoventilation syndrome (Pick-Wickian
  syndrome)
• Cerebrovascular disease

6
Hypercapnea
H
Anatomic changes
Hypoxia
Acidemia
A
Pulmonary Vessel Restriction
Increased Viscosity
Increased C.O.
C
Acidosis
Chronic Cor Pulmonale
Rt. Ventricular Failure
7
Pathologic Features

• Lung consistent with Specific diseases
• Common Features hypertrophy of microvasculatures
• Hallmark Rt. Ventricular Hypertrophy
• 60g 200g, gt 0.5 CM, RV/LV lt2.5
• Lt. Ventricular Hypertrophy
• Hypertrophy of Carotid Body

8
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

9
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 smokers

10
Lab. Findings

• X-Ray Prominent pulmonary hilum pulmonary
  artery dilatation
• Rt MPA gt 20 mm
• EKG P- pulmonale, RAD, RVH
• Echocardiography RVH, TR, Pulm. Hypertension
• ABG Hypoxemia, Hypercapnea, Respiratory
  acidosis
• CBC polycythemia
• Cardiac catheterization

11
Treatment

• Treat Underlying Disease COPD Tx, Steroid,
  Infection control, theophylline,
  medroxyprogesterone,
• Continuous O2 lt 2-3L/min
• Diuretics
• Phlebotomy
• Digoxin controversial
• Pul. Vasodilators
• Beta adrenergic agents
• Reduce Ventilation/Perfusion imbalance Amitrine
  bimesylate

12
Prognosis

• 1960-1970 3 yr mortality 50-60
• Recent times 5 - 10 years or more