COR PULMONALE
It is the alteration of right ventricular structure or function that is due to pulmonary hypertension caused by diseases affecting the lung or its vasculature, NOT LEFT HEART DIEASE causing right-heart-dis or congenital heart malformations.
NOTE RIGHT VENTRICULAR MUSCLE HYPERTROPHY*
PATHOPHYSIOLOGY of cor pulmonale:
dyspnea on exertion, fatigue, lethargy, chest pain, syncope with exertion, pitting peripheral edema, passive hepatic congestion may lead to complaints such as anorexia and right upper quadrant discomfort.
Auscultation of the heart also may reveal a systolic ejection murmur and, in more severe disease, a diastolic pulmonary regurgitation murmur.
b) Right ventricular hypertrophy is characterized by a prominent A wave in the jugular venous pulse, associated with a right-sided fourth heart sound and either a left parasternal heave or a downward subxiphoid thrust.
c) Right ventricular failure leads to systemic venous hypertension. This can produce a variety of findings, such as elevated jugular venous pressure with a prominent V wave, a right ventricular third heart sound, and a high-pitched tricuspid regurgitant murmur
EVALUATION: Chest radiography
• Electrocardiography
• Two dimensional and Doppler echocardiography (which can provide an indirect measurement of pulmonary artery pressure when tricuspid regurgitation is present)
• Pulmonary function tests
• Radionuclide ventriculography
• Magnetic resonance imaging
• Right heart catheterization
• Lung biopsy
TREATMENT: 1.Long term oxygen therapy
– Oxygen therapy relieves pulmonary vasoconstriction, thereby decreasing pulmonary vascular resistance; as a result, the right ventricle increases stroke volume and cardiac output. Renal vasoconstriction also may be relieved, resulting in an increase in urinary sodium excretion.
Oxygen therapy improves arterial oxygen content, providing enhanced delivery to the heart, brain, and other vital organs.
2. Diuretics — If right ventricular filling volume is markedly elevated, diuretic therapy might improve the function of both right and left ventricles.
3. Vasodilators — Several vasodilator agents (including hydralazine, nitrates, nifedipine, verapamil, and ACE inhibitors) have been utilized in an attempt to ameliorate pulmonary hypertension.
4. Theophylline and the sympathomimetic amines (terbutaline, etc) may have salutary effects not related to bronchodilation. Specifically, these agents may:
• Improve myocardial contractility
• Provide some degree of pulmonary vasodilation
• Enhance diaphragm endurance
5. Phlebotomy — In patients with severe polycythemia (hematocrit above 55 percent).
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