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20-September-2008 10:08:30 - Cor pulmonale Cor pulmonale Classification and external resources ICD-10 I26., I27. ICD-9 415.0 MeSH D011660 Cor pulmonale is a change in structure and function of the right ventricle of the heart as a result of a respiratory disorder. Right ventricular hypertrophy RVH is the predominant change in chronic cor pulmonale, whereas in 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, 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. Contents 1 Pathophysiology 2 Causes 3 Complications 4 Investigations 5 Treatment 6 External links Pathophysiology There are several mechanisms leading to pulmonary hypertension and cor pulmonale: Pulmonary vasoconstriction Anatomic changes in vascularization Increased blood viscosity Idiopathic or primary pulmonary hypertension Causes Acute: Massive pulmonary embolization Exacerbation of chronic cor pulmonale Chronic: COPD Loss of lung tissue following trauma or surgery Pierre Robin sequence End stage Pneumoconiosis Sarcoidosis Complications Blood backs up into the systemic venous system, including the hepatic vein. Chronic congestion in the 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 Complications section. This situation requires diuretics to decrease strain on the heart, sometimes nitrates to improve blood flow, phosphodiesterase inhibitors such as sildenafil or tadalafil and occasionally inotropes to improve heart contractility. CHF is a negative prognostic indicator in cor pulmonale. External links Cor Pulmonale extensive symptoms, causes, and other details Emedicine The Merck Manual of Diagnosis and Therapy: Cor Pulmonale Pulmonary Heart Disease Symptoms v d e Cardiovascular disease: heart disease - Circulatory system pathology I00-I52, 390-429 Ischaemic/ Acute coronary CHD: CAD - Coronary thrombosis - Coronary vasospasm - Coronary artery aneurysm Angina pectoris Prinzmetal's angina - Myocardial infarction heart attack Myocardial rupture - Dressler's syndrome Layers Pericardium Pericarditis Acute, Constrictive - Pericardial effusion - Cardiac tamponade - Hemopericardium Myocardium Myocarditis Cardiomyopathy: Dilated Alcoholic - Hypertrophic - Restrictive Loeffler endocarditis, Cardiac amyloidosis Arrhythmogenic right ventricular dysplasia Endocardium/ valves Endocarditis Subacute bacterial endocarditis, Libman-Sacks endocarditis, Nonbacterial thrombotic endocarditis mitral regurgitation, prolapse, stenosis - aortic stenosis, insufficiency - tricuspid stenosis, insufficiency - pulmonary stenosis, insufficiency Conduction/ arrhythmia Heart block AV 1°, 2°, 3° - Bundle branch Left, Right - Bifascicular/Trifascicular - Sinoatrial - Sick sinus syndrome - Adams-Stokes syndrome Pre-excitation syndrome Wolff-Parkinson-White - Lown-Ganong-Levine Tachycardia Paroxysmal - Supraventricular AV nodal reentrant, Accelerated idioventricular rhythm, Sinus - Ventricular Torsades de pointes, Catecholaminergic polymorphic Premature contraction Atrial - Ventricular Flutter/fibrillation Atrial flutter - Ventricular flutter - Atrial fibrillation Familial - Ventricular fibrillation Pacemaker Wandering pacemaker - Ectopic pacemaker - Parasystole Long QT syndrome Romano-Ward syndrome - Andersen-Tawil syndrome - Jervell and Lange-Nielsen syndrome Cardiac arrest Sudden cardiac death - Asystole Other Cardiomegaly - Ventricular hypertrophy Left, Right/Cor pulmonale Heart failure Cardiac asthma - Rheumatic fever See also congenital, neoplasia Retrieved from http://en..org/wiki/Cor_pulmonale Categories: Cardiology | Pulmonology Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages Deutsch Español Italiano Nederlands 日本語 Polski Português РуÑ?Ñ?кий Svenska This page was last modified on 13 July 2008, at 17:5
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