This document discusses cor pulmonale, which is right heart failure or pulmonary heart disease that occurs secondary to lung or pulmonary vascular diseases. It defines cor pulmonale and describes the types as acute or chronic. It covers the etiology, pathogenesis, clinical features, investigations and treatment of cor pulmonale. The main causes are chronic obstructive pulmonary disease and pulmonary embolism. Signs and symptoms include dyspnea and right heart failure. Treatment involves managing the underlying lung or vascular condition, administering oxygen therapy, and treating right heart failure.

1. COR PULMONALE
HARISREE.V
ROLL NO.29
2017 REGULAR

2. • Definition
• Types
• Aetiology
• Pathogenesis
• Clinical features-signs and symptoms
• Investigations
• Treatment

3. COR PULMONALE
• Pulmonary heart disease
• Dilatation with or without hypertrophy of right ventricle - in
response to diseases of the pulmonary vasculature or lung
parenchyma.
• Without left sided heart disease.
• Right heart dysfunction is results from pulmonary hypertension
• Pulmonary HTN :-Pulmonary arterial pressure above 25 mmHg,
left atrial pressure or left ventricular end-diastolic pressure of
less than 15 mmHg.

4. TYPES
• ACUTE COR PULMONALE
• CHRONIC COR PULMONALE

5. ACUTE COR PULMONALE
• Occurs following a massive pulmonary embolism- sufficient enough
to obstruct more than 60 % of pulmonary circulation.
• Leads to acute pulmonary hypertension → Acute right ventricular
dilatation → failure.

6. CLINICAL FEATURES :-
 Signs of deep vein thrombosis
 Acute dyspnoea, Haemoptysis
 Syncope or cardiac arrest
 Tachypnoea , Tachycardia ,Hypotension
 Chest pain

7. CLINICAL FEATURES (cond)
 Signs of acute right ventricular failure
. Raised JVP
. Parasternal heave
. Right ventricular 3rd heart sound and gallop

8. CHRONIC COR PULMONALE
• Combination of hypertrophy and dilatation of right ventricle
• Secondary to pulmonary hypertension, results from diseases of lung,
pulmonary circulation or thorax .

9. ETIOLOGY
DISEASES OF LUNG DISEASES OF PULMONARY
CIRCULATION
 COPD  Recurrent pulmonary
Thromboembolism
 Chronic bronchial asthma  Primary pulmonary HTN
 Pulmonary tuberculosis  Collagen vascular diseases
 Interstitial lung disease  Chronic liver disease
 Cystic fibrosis
 Pleural fibrosis

10. ETIOLOGY (Cond)
DISEASES OF THORAX
 Kyphoscoliosis
 Neuromuscular diseases
 Sleep apnoea syndrome
 Obesity

11. ETIOLOGY Cond….
• COPD including chronic bronchitis and emphysema
• Causes more than 50 % cases of chronic cor pulmanale.
• Patients with chronic bronchitis develop
erythrocytosis,oedema and early onset of cor pulmonale -
BLUE BLOATERS
• Patients with emphysema develop cor pulmonale later -
PINK PUFFERS

12. PATHOGENESIS
• Increased pulmonary vascular resistance
Pulmonary hypertension central mechanisms
in chronic cor pulmonale
• Hypoxaemia- Promotes vasoconstriction and Vascular remodelling by
stimulating smooth muscle proliferation

13. PATHOGENESIS
PULMONARY DISEASES
↓
HYPOXIA,HYPERCAPNIA/ ACIDOSIS
PULMONARY DESTRUCTION OF CAPPILLARY BED BLOOD VOLUME ↑
VASOCONSTRICTION BLOOD VISCOSITY ↑
PULMONARY HYPERTENSION
RIGHT VENTRICULAR HYPERTROPHY
RIGHT HEART FAILURE

14. CLINICAL FEATURES
SYMPTOMS:-
• Dyspnoea, not relieved by sitting up -due to pulmonary hypertension
• Dry cough
• Fatigue
• Atypical anterior chest pain -due to dilatation of the root of
pulmonary artery
• Exercise- induced peripheral cyanosis and excessive day time
somnolence

15. SIGNS
• Tachypnoea ,even on mild exertion
• Ankle oedema
• Prominent a waves on JVP
• Right ventricular heave in left parasternal region and epigastrium
• Loud pulmonary component (P2) of second heart sound
• Right sided fourth heart sound
• Pulmonary ejection sound
• Ejection systolic murmur at pulmonary area
• Pan systolic murmur of tricuspid regurgitation – with very high
pulmonary arterial pressure
• Early diastolic murmur of pulmonary regurgitation- with very high
pulmonary arterial pressure

16. OVERT RIGHT HEART FAILURE
• Overt RHF in a patient with chronic cor pulmonale is suggested
by the following signs:
Increasing peripheral oedema
Raised JVP and positive hepatojugular reflux
Tender hepatomegaly
Cardiac enlargement
Right ventricular third heart sound and a gallop rhythm
Right sided fourth heart sound

17. INVESTIGATIONS
• Chest X-ray –Cardiac enlargement due to dilatation of right ventricle
• ECG –Features of right atrial enlargement and right ventricular hypertrophy
• ABG studies –HYPOXIA and HYPERCAPNEA
• Echocardiography –Chamber hypertrophy and enlargement
• BNP –Useful biomarker for pulmonary HTN on patients with COPD
• Nuclear scan – for pulmonary embolism

18. MANAGEMENET OF COR PULMONALE
General measures
 Treatment to decrease pulmonary hypertension
 Treatment of right heart failure
Additional measures in COPD induced cor pulmonale
Surgical treatment

19. GENERAL MEASURES :-
I. TREATMENT TO DECREASE PULMORY HYPERTENTION
• Treatment of underlying disease
• OXYGEN THERAPY-Most imp treatment in reducing pulmonary
hypertension
 Initiated if arterial oxygen tension is 55mmHg or less
Oxygen should be administered in a controlled manner .The inspired
oxygen concentration is adjusted to produce PaO2 of 60 mmHg or
more.
Oxygen administered for a minimum period of 12-15 hours / day .

20. 2. TREATMENT OF RIGHT HEART FAILURE
• Diuretics
• Phlebotomy when haematocrit is more than 60%
• Sildenafil, a phosphodiesterase-4 inhibitor-used for pulmonary
hypertension
• Digoxin
• Salt restriction

21. ADDITIONAL MEASURES IN COPD -INDUCED COR PULMONALE
• Avoidance of airway irritants like tobacco smoke
• Bronchial toilet for removal of secretions
• Treatment of respiratory infections with antibiotic
• Bronchodilators
• Corticosteroids in patients with bronchospasm
• Tranquillisers , sedatives and narcotics are preferably avoided

22. SURGICAL TREATMENT :-
• Pulmonary embolectomy in unresolved pulmonary emboli
• Heart - Lung transplantation in patients with primary pulmonary
hypertension
• Unilateral lung transplantation in patients with interstitial lung
disease.

23. THANK YOU