Definition and Overview

Cor pulmonale refers to right-sided heart failure. It is common in people with chronic lung diseases. Such diseases can increase blood pressure in the blood vessels of the lungs. This forces the right ventricle to work harder to pump blood. If left untreated, the right ventricle will enlarge and will not be able to pump blood to the lungs as well as normal.

Causes of Condition

Cor pulmonale can occur for a number of reasons. However, the most common cause is chronic obstructive pulmonary disease (COPD), an umbrella term for a number of lung disorders. These include emphysema and chronic bronchitis.

It can also occur due to:

  • Cystic fibrosis - A disorder that can cause damage to many organs in the body. It causes secretions, such as mucous, to become thick and sticky. Thus, instead of acting as lubricants, the secretions cause blockage to passageways.

  • Obstructive sleep apnoea - A disorder that causes a person to stop breathing for several seconds while asleep. This occurs when throat muscles become relaxed. As a result, they block the airway while the patient is sleeping. It also causes a person to snore loudly. This can be a cause for concern because it can happen at least five times per hour.

  • Blood clots - Blood clots can occur anywhere in the body and cause obstruction. Small blood clots can cause partial blockage. Big ones, on the other hand, can cut off blood flow to the rest of the body.

Key Symptoms

The condition does not have signs in the early stages. Thus, it is often found when it has already advanced. Because of this, it can be very difficult to treat. Its first symptoms are shortness of breath and lightheadedness during physical activity. But because the symptoms are very similar to what a person feels during exercise, they do not often prompt patients to go to their doctor.

When the condition gets worse, the symptoms can occur even while the patient is resting. Other symptoms also develop. These include a faster heart rate and being unusually tired most of the time.

Patients also present symptoms of their lung condition. These include wheezing and weakness as well as chronic coughing and fatigue.

Who to See and Types of Treatments Available

Cor pulmonale is always suspected in patients with COPD. It can be confirmed with the following tests:

  • Echocardiography - Also called an echo, this test creates moving pictures of the heart using sound waves. It is a simple procedure that does not require numbing drugs. It is painless and does not have side effects. It can detect changes both in the right and left ventricles.

  • Imaging tests - A chest x-ray, a CT scan, and an MRI also provide pictures of the chest area. They can show if the right ventricle or pulmonary artery is enlarged. An MRI can also show the volume of the pulmonary arteries as well as assess cardiac chambers and function.

  • Right heart catheterisation - This test may be required for confirmation. For the procedure, a catheter is guided into the right side of the heart and then into the blood vessels leading to the lungs. The doctor will then observe blood flow through the heart. The blood pressure in the artery is also measured. This test also allows doctors to monitor heart function. If there are signs of heart failure, the doctor will provide treatment right away.

Patients are often treated with:

  • Oxygen therapy - Patients with the condition have a hard time breathing properly. This can lead to a number of problems because all the organs in the body need oxygen to function. Thus, doctors immediately connect patients to an oxygen tank.

  • Diuretics - These work by increasing the amount of water and salt in the urine. This helps because too much salt in the body can cause fluid to build up in blood vessels. By using diuretics, more blood can flow through the arteries.

  • Vasodilators - These drugs work by widening the blood vessels. They do so by preventing the muscles from tightening. Thus, blood flows more easily through the blood vessels.

  • Anticoagulants - The body makes blood clots to prevent severe blood loss when a person is wounded. But these clots can cause problems if they block blood vessels. Anticoagulants prevent the blood from clotting.

  • Bronchodilators - These medications help relax the muscles in the lungs so the patient can breathe normally. They also help widen the airways.

  • Antibiotics - These are used to treat respiratory infections.

To cure cor pulmonale is to treat the underlying lung condition. Unfortunately, this is not possible in many cases. Despite many advances in the field of medicine, there is still no cure for COPD. Available treatments can only control its symptoms and slow down its progression. In severe cases, patients may opt to undergo a lung transplant. In this procedure, the diseased lungs are removed and replaced with healthy lungs from a donor.

References:

  • Tunariu N, Gibbs SJ, Win Z, et al. Ventilation-perfusion scintigraphy is more sensitive than multidetector CTPA in detecting chronic thromboembolic pulmonary disease as a treatable cause of pulmonary hypertension. J Nucl Med. 2007 May. 48 (5):680-4.

  • Shih WJ, Kousa K, Mitchell B, Huang WS. Permanently increased brightness of right ventricle (D-shaped left ventricle) on myocardial perfusion imaging in a patient with chronic cor pulmonale: an autopsy correlation. J Nucl Cardiol. 2006 Mar-Apr. 13(2):294-6.

  • Singh H, Ebejer MJ, Higgins DA, Henderson AH, Campbell IA. Acute haemodynamic effects of nifedipine at rest and during maximal exercise in patients with chronic cor pulmonale. Thorax. 1985 Dec. 40(12):910-4.

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