Cor pulmonale 368300 225433658 2008-07-13T17:53:15Z Travisthurston 248002 /* Pathophysiology */ -redirect changes: vascularization -> vasculature {{Infobox_Disease | Name = {{PAGENAME}} | Image = | Caption = | DiseasesDB = | ICD10 = {{ICD10|I|26||i|26}}, {{ICD10|I|27||i|26}} | ICD9 = {{ICD9|415.0}} | ICDO = | OMIM = | MedlinePlus = | eMedicineSubj = | eMedicineTopic = | MeshID = D011660 | }} '''Cor pulmonale''' is a change in structure and function of the [[right ventricle]] of the heart as a result of a [[Respiratory system|respiratory]] disorder. [[Right ventricular hypertrophy]] (RVH) is the predominant change in [[chronic (medicine)|chronic]] cor pulmonale, whereas in [[Acute (medical)|acute]] cases, [[dilation]] dominates. Both hypertrophy and dilation are the result of increased right ventricular pressure. Dilation is essentially a stretching of the ventricle, the immediate result of increasing the pressure in an elastic container. Ventricular hypertrophy is an adaptive response to a long-term increase in pressure. Additional muscle grows to allow for the increased contractile force required to move the blood against greater resistance. To be classified as cor pulmonale, the cause must originate in the [[pulmonary circulation]] system. Two major causes are vascular changes as a result of tissue damage (e.g., disease, [[hypoxia (medical)|hypoxic injury]], chemical agents, etc.), and chronic [[hypoxic pulmonary vasoconstriction]]. RVH due to a [[systemic]] defect is not classified as cor pulmonale. Left untreated, cor pulmonale can lead to right-heart failure and death. ==Pathophysiology== There are several mechanisms leading to pulmonary hypertension and cor pulmonale: * Pulmonary [[vasoconstriction]] * Anatomic changes in [[Vasculature|vascularization]] * Increased blood [[viscosity]] * Idiopathic or primary [[pulmonary hypertension]] ==Causes== * Acute: ** [[Pulmonary embolism|Massive pulmonary embolization]] ** Exacerbation of chronic cor pulmonale * Chronic: ** [[Chronic obstructive pulmonary disease|COPD]] ** Loss of lung tissue following trauma or surgery ** [[Pierre Robin syndrome|Pierre Robin sequence]] ** End stage [[Pneumoconiosis]] ** [[Sarcoidosis]] ==Complications== Blood backs up into the systemic venous system, including the [[hepatic vein]]. Chronic congestion in the [[Hepatic lobule| centrilobular]] region of the liver leads to hypoxia and fatty changes of more peripheral [[hepatocytes]], leading to what is known as [[nutmeg liver]]. ==Investigations== * [[Chest X-Ray]] - Right ventricular hypertrophy, right atrial dilatation, prominent pulmonary artery, peripheral lung fields show reduced vascular markings * [[ECG]] - Right ventricular hypertrophy - right axis deviation, prominent R wave in lead V1 & inverted T waves in right precordial leads * [[Echocardiogram]] - Right ventricular dilatation and tricuspid regurgitation is likely ==Treatment== Elimination of the cause is the most important intervention. Diuretics for RVF, In [[pulmonary embolism]], [[thrombolysis]] (enzymatic dissolution of the blood clot) is advocated if there is dysfunction of the right ventricle. In COPD, long-term [[oxygen therapy]] may improve cor pulmonale. Cor pulmonale may lead to [[congestive heart failure]] (CHF), with worsening of respiration due to [[pulmonary edema]], swelling of the legs due to [[peripheral edema]] and painful congestive hepatomegaly (enlargement of the liver due to tissue damage as explained in the [[Cor pulmonale#Complications|Complications]] section. This situation requires [[diuretic]]s (to decrease strain on the heart), sometimes [[nitrate]]s (to improve blood flow), [[phosphodiesterase inhibitor]]s such as [[sildenafil]] or [[tadalafil]] and occasionally [[inotrope]]s (to improve heart contractility). CHF is a negative [[prognosis|prognostic indicator]] in cor pulmonale. == External links == * [http://www.heartd.org/corpulmonale.php Cor Pulmonale extensive symptoms, causes, and other details] * [http://www.emedicine.com/med/topic449.htm Emedicine] * The Merck Manual of Diagnosis and Therapy: [http://www.merck.com/mrkshared/mmanual/section16/chapter203/203c.jsp Cor Pulmonale] * [http://www.pulmonaryheartdisease.com Pulmonary Heart Disease Symptoms] {{Circulatory system pathology}} [[Category:Cardiology]] [[Category:Pulmonology]] [[de:Cor pulmonale]] [[es:Cor pulmonale]] [[it:Cuore polmonare]] [[nl:Cor pulmonale]] [[ja:肺性心]] [[pl:Serce płucne]] [[pt:Cor pulmonale]] [[ru:Лёгочное сердце]] [[sv:Lung-hjärtsjukdom]]