Cor pulmonale is the enlargement and failure of the right ventricle of the heart in response to lung disease or other causes of increased pulmonary pressure. It has a chronic progressive course but can also worsen acutely with life-threatening complications. Key factors in cor pulmonale include pulmonary hypertension from conditions like COPD, pulmonary embolism, or vascular disease, leading to right ventricular hypertrophy and eventually right-sided heart failure if left untreated. Prognosis depends on underlying cause and can be improved with treatments like oxygen therapy and smoking cessation.

1. COR
PULMONALE
-MR. MIGRON RUBIN

2. INTRODUCTION
– Pulmonary hypertension is often the common link between lung dysfunction and the heart in cor
pulmonale.
– cor pulmonale commonly has a chronic and slowly progressive course, acute onset or worsening cor
pulmonale with life-threatening complications can occur.

3. KEY WORDS
– Cor pulmonale- It is alteration in the structure and function of the right ventricle (RV) of the heart.
– Proliferation- It is the growth or production of cells by multiplication of parts.
– Lingula- The lingula is a combined term for the two lingular bronchopulmonary segments of the left
upper lobe: superior lingular segment. inferior lingular segment.

4. ANATOMY OF HUMAN HEART
– Pericardium
 The heart sits within a fluid-filled cavity called the pericardial cavity.
 The walls and lining of the pericardial cavity are a special membrane known as
the pericardium.
 Pericardium is a type of serous membrane that produces serous fluid to lubricate
the heart and prevent friction between the ever beating heart and its surrounding
organs.

5. Structure of the Heart Wall
– The heart wall is made of 3 layers: epicardium, myocardium and endocardium.
 Epicardium-The epicardium is the outermost layer of the heart wall and is just
another name for the visceral layer of the pericardium.
 Myocardium-The myocardium is the muscular middle layer of the heart wall that
contains the cardiac muscle tissue.
 Myocardium makes up the majority of the thickness and mass of the heart wall and is
the part of the heart responsible for pumping blood.
 Endocardium.- Endocardium is the simple squamous endothelium layer that lines
the inside of the heart.

6. – Chambers of the Heart
– The heart contains 4 chambers: the right atrium, left
atrium, right ventricle, and left ventricle.

7. Valves of the Heart
 Atrioventricular valves. The atrioventricular (AV) valves
are located in the middle of the heart between the atria and
ventricles and only allow blood to flow from the atria into the
ventricles.
 The AV valve on the right side of the heart is called the
tricuspid valve because it is made of three cusps (flaps).
 Semilunar valves. The semilunar valves, so named for the
crescent moon shape of their cusps, are located between the
ventricles and the arteries that carry blood away from the
heart.
 The semilunar valve on the right side of the heart is the
pulmonary valve, so named because it prevents the backflow
of blood from the pulmonary trunk into the right ventricle.

8. Conduction System of the Heart
 The conduction system starts with the pacemaker of the
heart—a small bundle of cells known as the sinoatrial (SA)
node.
 The AV node is located in the right atrium in the inferior
portion of the interatrial septum.
 The AV node picks up the signal sent by the SA node and
transmits it through the atrioventricular (AV) bundle.

9. – LUNGS
– The lungs are located in the chest on either side of the heart in the rib cage.
– They are conical in shape with a narrow rounded apex at the top and a broad base
that rests on the diaphragm.
– The apex of the lung extends into the root of the neck, reaching shortly above the
level of the sternal end of the first rib.

10. – The lungs are surrounded by the pulmonary pleurae.
– The pleurae are two serous membranes.
– Between the pleurae is a potential space called the pleural cavity containing
pleural fluid.
– Each lung is divided into lobes by the invaginations of the pleura as fissures. The
fissures are double folds of pleura that section the lungs and help in their
expansion.
– The lobes of the lungs are further divided into bronchopulmonary segments
based on the locations of bronchioles .The segmental anatomy is useful
clinically for localizing disease processes in the lungs.

11. – Right Lung-The right lung has both more lobes and segments than the left. It is
divided into three lobes, an upper, middle, and a lower, by two fissures, one
oblique and one horizontal.
– Left lung- The left lung is divided into two lobes, an upper and a lower, by the
oblique fissure, which extends from the costal to the mediastinal surface of the
lung both above and below the hilum.

13. DEFINITION
– Cor pulmonale is defined as an alteration in the structure and function of the
right ventricle (RV) of the heart caused by a primary disorder of the respiratory
system.

14. ETIOLOGY
– Pulmonary Vascular disease
– Pulmonary embolism
– COPD

15. PATHOPHYSIOLOGY
Due to etiological factors ( hormonal, mechanical & others)
Pulmonary endothelial injury
 smooth muscle proliferation.
 vascular scarring
Sustained Pulmonary Hypertension
Right Ventricle Hypertrophy
Cor Pulmonale
Right sided heart failure

16. CLINICAL MANIFESTATIONS
– Fatigue
– Tachypnea
– Exertional dyspnea
– Cough.
– Cyanosis can be seen in chest
– Chronic Hypoxemia
– Anginal pain -due to right ventricular ischemia
– Hemoptysis - due to rupture of a dilated or atherosclerotic
pulmonary arteriole.
– Right upper quadrant abdominal discomfort, and jaundice.
– Peripheral edema occurs due to elevated pulmonary artery
pressure

17. DIAGNOSTIC EVALUATION
– History Collection
– Physical Examination-increase in chest diameter,
distended neck veins and cyanosis may be seen.
– On auscultation of the lungs, wheezes and crackles
may be heard .
– On percussion, hyper-resonance of the lungs may be
a sign of underlying COPD.
– Pulmonary function tests
– ABG analysis- Reveals decreased PaO2 & pH and
Increased PaCo2.(hypercapnia).

18. – Hematocrit count- It is done for polycythemia,
– Serum alpha1-antitrypsin, if deficiency is suspected
– Antinuclear antibody (ANA) level for collagen vascular disease, and anti-SCL-70 antibodies in scleroderma
– Coagulations studies to evaluate hypercoagulability states (eg, serum levels of proteins S and C, antithrombin III, factor V
Leyden, anticardiolipin antibodies, homocysteine)
– Brain Natriuretic Peptide-Brain natriuretic peptide (BNP) is a peptide hormone that is released in response to volume
expansion.
– ECG – ECG changes can be seen due to Right Ventricle Hypertrophy. ECG changes may include the following:
– Right axis deviation
– P-pulmonale pattern (an increase in P wave amplitude in leads 2, 3, and aVF)
– Low-voltage QRS because of underlying COPD with hyperinflation
– 2-D and Doppler Echocardiography-
– Magnetic Resonance Imaging
– Cardiac Catheterization

19. MANAGEMENT
I. Medical Management
A. Pharmacological Management
– Diuretics
– Calcium channel blockers
– Vasodilator drugs
– Bronchodilators- Theophylline
– Warfarin- Anticoagulation with warfarin is
recommended in patients at high risk for
thromboembolism.
– Thrombolytic therapy
– Inotropes with vasodilatory properties

20. B. Non Pharmacological Management
– Oxygen Therapy

21. II. Surgical Management
– Phlebotomy
– Lung transplantation

22. Nursing Management
– Assessment
– Determine if the patient has experienced orthopnea, cough, fatigue, epigastric distress, anorexia, or
weight gain or has a history of previously diagnosed lung disorders.
– Ask if the patient smokes cigarettes, noting the daily consumption and duration.
– Ask about the color and quantity of the mucus the patient expectorates.
– Determine the type of dyspnea if it is related only to exertion or is continuous.
– Observe if the patient has difficulty in maintaining breath while the history is taken.
– Evaluate the rate, type, and quality of respirations.
– Observe the patient for dependent edema from the abdomen (ascites) and buttocks and down both legs.
– Inspect the patient's chest and thorax for the general appearance and anteroposterior diameter.
– Look for the use of accessory muscles in breathing.

23. – Nursing Diagnosis
– Impaired gas exchange related to excess fluid in lungs; increased pulmonary
vascular resistance.
– Decreased cardiac output related to an ineffective ventricular pump
– Excess Fluid volume related to right sided heart failure
– Acute pain related to right ventricular ischemia & decreased oxygen supply
– Activity intolerance related to abnormal pulse, ECG changes & chest pain.

24. COMPLICATIONS
– Exertional syncope.
– Hypoxia and significantly limited exercise tolerance.
– Peripheral oedema.
– Peripheral venous insufficiency.
– Tricuspid regurgitation.
– Hepatic congestion and cardiac cirrhosis.
– Death.

25. PROGNOSIS
– The overall five-year survival rate for cor pulmonale complicating COPD is
approximately 50%.
– Prognosis also appears to be significantly improved by smoking cessation and
correct use of long term o2 therapy.

26. HEALTH EDUCATION
– Advice patient to take protein rich diet.
– Educate patient regarding his disease condition.
– Educate patient regarding modification in lifestyle like cessation of smoking &
alcohol consumption.
– Advice patient to reduce spicy & fatty foods.
– Instruct patient to avoid caffeine intake which can increase pulse rate &
produce angina.
– Educate patient to minimize level of activities to prevent strain.
– Advice patient for regular follow-up & care.

27. RELATED RESEARCH
– Boissier, F., Katsahian et. Al . (2013). Conducted a study to assess Prevalence
and prognosis of cor pulmonale during protective ventilation for acute
respiratory distress syndrome. The study was conducted among 226 patients
with ARDS revealed cor pulmonale in 22% .A greater proportion of patients with
cor pulmonale (79.6%) had infection-related lung injuries compared to patients
without lung injury (57.6%) (p value < 0.01). Having an infection-related lung
injury was associated with a 2.87 (p < 0.01) increased risk of cor pulmonale. In
this sample, 28-day mortality rates were higher among patients with cor
pulmonale (60%) than patients without (30%).

28. THEORY APPLICATION
MODIFIED WHOLLY COMPENSATORY SYSTEM
Accomplishes patient’s therapeutic self-care
Compensates for patient’s inability to engage in self-care
Supports and protect patient
Nurse action
 Oxygenation
 Suctioning
 Input & output
maintenance
 Ventilator care
 Postop care etc.

29. – PRESENTER’S VIEW
– Cor pulmonale commonly has a chronic and slowly progressive course, acute onset
or worsening cor pulmonale with life-threatening complications can occur. Cor
pulmonale has poor prognosis.
– SUMMARY
– Pulmonary heart disease, also known as cor pulmonale is the enlargement and
failure of the right ventricle of the heart as a response to increased vascular
resistance (such as from pulmonic stenosis) or high blood pressure in the lungs. Cor
pulmonale is failure of the right side of the heart.

30. THANKYOU