Cor Pulmonale

Cor pulmonale is a heart disease in which there is an alteration in the function and structure of the right heart (right ventricle) as a result of increased pressure in the pulmonary circulation (pulmonary hypertension).

Any disease of the cardio-respiratory system that causes pulmonary hypertension producing an overload of work on the right side of the heart can cause cor pulmonale.

How is it produced?

Under normal conditions, the right heart is responsible for receiving a large volume of non-oxygenated blood, thus it has thin and compliant walls that adapt to the amount received. blood that reaches the right heart is pumped through the right ventricle to the pulmonary artery and reaches the lungs to be oxygenated.

When due to a disease of the lung or of the pulmonary circulation (pulmonary artery) there is an increase in pressure (pulmonary hypertension) the right heart has difficulties pumping blood since its thin walls cannot counteract this increase in resistance and a failure occurs in its operation. As a consequence, the right ventricle increases in volume (dilation) and thickness (hypertrophy). It causes a situation of right heart failure that leads to a prolonged decrease in oxygen supply to the blood.

Cor pulmonale can be secondary to a wide variety of cardiopulmonary diseases. It can appear after an acute lung disease such as a pulmonary embolism or, much more frequently, be the consequence of a chronic lung disease (chronic cor pulmonale).

The most common cause of cor pulmonale is chronic obstructive pulmonary disease (copd) but any lung disease can cause cor pulmonale such as asthma, cystic fibrosis, sleep apnea or primary pulmonary hypertension, among others.

Symptoms

Symptoms of the lung disease that causes it appear, for example, chronic cough, dyspnea or a feeling of shortness of breath, etc.

Other symptoms are due to the malfunction of the right heart that manifests as an accumulation of fluid in the legs (edema) and abdomen (ascites), enlargement of the liver (hepatomegaly) and dilation of the neck veins. These symptoms become more apparent as the disease progresses.

Diagnosis

The diagnosis of cor pulmonale is based on the patient's medical history that allows suspicion of an underlying disease along with a series of tests that help confirm right heart failure.

• The recording of the electrocardiogram may be suggestive of the enlargement of the right heart chambers and pulmonary hypertension.
• The arterial blood gas indicates the level of oxygenation of the blood.
• Imaging tests such as echocardiography, CT and MRI allow us to see the structure of the heart and lung and determine the causes of cor pulmonale as well as the degree of cardiopulmonary involvement.
• Ventilation-perfusion scintigraphy is a test that is used especially in pulmonary embolism to see the affected lung areas.
• Cardiac catheterization is a test that measures the pressure in the chambers of the right heart and the pulmonary artery, confirming the diagnosis.

Treatment

Treatment is aimed at treating the cause of the disease that is causing cor pulmonale as well as improving oxygenation and the function of the right ventricle. The most serious problem is pulmonary hypertension. In many cases, the disease causing hypertension is so advanced that there are few effective treatments.

• Drugs are used to treat the underlying disease: for example anticoagulants if there is a thromboembolism or bronchodilators in chronic bronchitis.
• Treatment to relieve symptoms caused by right ventricular failure: diuretics are used to accumulate fluids; drugs to improve ventricular function and to lower pulmonary and systemic artery pressure (vasodilators).
• Low salt diet.
• Administration of oxygen.
• In selected cases, ultimately lung or heart-lung transplantation may be the only curative treatment alternative.

Prevention

The most common cause of chronic cor pulmonale is copd. smoking is the most common cause of copd, therefore, not smoking will prevent the onset of chronic lung diseases and the development of cor pulmonale.