Cor Pulmonale
Basics
Description
Right ventricular hypertrophy (RVH) or dilation caused by elevated pulmonary artery pressure. RVH due to a systemic defect or congenital heart disease is not classified as cor pulmonaleDescription
- Acute cor pulmonale:
- Right ventricle is dilated and muscle wall stretched thin
- Overload due to acute pulmonary hypertension (HTN)
- Most often caused by massive pulmonary embolism
- Chronic cor pulmonale:
- RVH with eventual dilation and right-sided heart failure
- Caused by an adaptive response to chronic pulmonary HTN
- Predominately occurs as a result of alveolar hypoxia
- The pulmonary circulation is a low-resistance, low-pressure system:
- The pulmonary arteries are thin walled and distensible
- Mean pulmonary arterial pressure is usually 12–15 mm Hg
- Normal left atrial pressure is 6–10 mm Hg
- The resulting pressure difference driving the pulmonary circulation is only 6–9 mm Hg
- 3 factors affect pulmonary arterial pressure:
- Cardiac output
- Pulmonary venous pressure
- Pulmonary vascular resistance
- Pulmonary HTN can arise through a number of mechanisms:
- A marked increase in cardiac output
- Left-to-right shunt secondary to congenital heart disease
- Hypoxia:
- The most common cause of increased pulmonary vascular resistance
- Hypoxic pulmonary vasoconstriction is an adaptive vasomotor response to alveolar hypoxia
- A compensatory rise in pressure is seen in the pulmonary arterial system, so flow is maintained across the pulmonary vascular bed
- Pulmonary embolus causes a similar change by increasing resistance to pulmonary blood flow
- Dramatic rises in blood viscosity or intrathoracic pressure also impede blood flow
- Pulmonary HTN is classified into 5 groups:
- Group 1: Pulmonary arterial HTN
- Group 2: Pulmonary HTN owing to left heart disease:
- RV dysfunction in this category is not considered cor pulmonale
- Group 3: Pulmonary HTN owing to lung diseases and/or hypoxia
- Group 4: Chronic thromboembolic pulmonary HTN
- Group 5: Pulmonary HTN with unclear multifactorial mechanisms
Epidemiology
IncidenceEpidemiology
- ∼86,000 patients die from COPD each year:
- Associated RV failure is a significant factor in many of these cases, and accounts for 10–30% of heart failure admissions in the U.S.
- In patients >50 yr with COPD, 50% develop pulmonary HTN and are at risk of developing cor pulmonale
- The course of cor pulmonale is generally related to the progression of the underlying disease process
- Once cor pulmonale develops, patients have a 30% chance of surviving 5 yr
Etiology
Etiology
- Chronic hypoxia
- COPD
- High-altitude dwellers
- Sleep apnea
- Chest deformities:
- Kyphoscoliosis
- Pulmonary embolism
- Interstitial lung disease:
- Scleroderma
- Systemic lupus erythematosus
- Mixed connective tissue disease
- Sarcoidosis
- Pulmonary Langerhans cell histiocytosis
- Neurofibromatosis type
- Lymphangioleiomyomatosis
- Cystic fibrosis
- Severe anemia
- Obesity
- Pulmonary veno-occlusive disease
- Pulmonary vascular obstruction secondary to tumors or adenopathy
- Increased blood viscosity:
- Polycythemia vera
- Leukemia
- Increased intrathoracic pressure:
- Mechanical ventilation with positive end-expiratory pressure
- Idiopathic primary pulmonary HTN
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Citation
Schaider, Jeffrey J., et al., editors. "Cor Pulmonale." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307077/1.2/Cor_Pulmonale.
Cor Pulmonale. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307077/1.2/Cor_Pulmonale. Accessed December 3, 2024.
Cor Pulmonale. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307077/1.2/Cor_Pulmonale
Cor Pulmonale [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 December 03]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307077/1.2/Cor_Pulmonale.
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