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Cor pulmonale is a medical term used to describe a change in structure and function of the right ventricle of the heart as a result of a respiratory disorder. RVH (right ventricular hypertrophy is the predominant change in chronic cor pulmonale, however 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 force in contraction required to move the blood against greater resistance. To be classified as cor pulmonale, the cause must originate in the pulmonary circulation. Vascular remodelling of the pulmonary circulation as a result of tissue damage (causes including disease, hypoxic injury, chemical agents, etc.) or chronic hypoxic vasoconstriction are two major causes. 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:
Causes
- Acute:
- Chronic:
- COPD
- Loss of lung tissue following trauma or surgery
Treatment
Elimination of the cause is the most important intervention. 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. This situation requires diuretics (to decrease strain on the heart), sometimes nitrates (to improve blood flow) and occasionally inotropes (to improve heart contractility). CHF is a negative prognostic indicator in cor pulmonale.
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