Cor Pulmonale

Cor Pulmonale Sung Chul Hwang, M.D. Dept. of Pulmonary and Critical Care Medicine Ajou University School of Medicine

Cor Pulmonale • Right Sided Heart Disease, secondarily caused by abnormalities of lung parenchyme, airways, thorax, or respiratory control mechanisms. • Noevidence of other heart conditions, • Acute vs. Chronic

Etiology of Cor Pulmonale ( I )

• • • • •

Lung and Airways COPD Asthma Bronchiectasis DILD Pulmonary tuberculosis

• • • • •

Vascular Occlusion Multiple Emboli Schistosomiasis Filariasis Sickle Cell P. Pulmonary Hypertension

Etiology of Cor Pulmonale ( II ) • • • •

Thoracic Cage Kyphosis > 100 o Scoliosis > 120 o Thoracoplasty Pleural fibrosis

• • • •

N-M Disease Polio Myelitis Myasthenia Gravis ALS Muscular Dystrophy

Etiology of Cor Pulmonale ( III ) Abnormal Respiratory Control • Idiopathic hypoventilation Syndrome • Obesity hypoventilation syndrome (Pick-Wickian syndrome) • Cerebrovascular disease

Hypercapnea H

Hypoxia

Acidemia

Anatomic changes

A

Pulmonary Vessel Restriction Increased Viscosity Acidosis

Increased C.O. C

Chronic Cor Pulmonale Rt. Ventricular Failure

Pathologic Features • Lung : consistent with Specific diseases • Common Features: hypertrophy of microvasculatures • Hallmark : Rt. Ventricular Hypertrophy 60g – 200g, > 0.5 CM, RV/LV <2.5 • Lt. Ventricular Hypertrophy • Hypertrophy of Carotid Body

Natural History • Several months to years to develop • All ages from child to old people • Repeated infections aggravate RV strain into RV failure • Initilly respondes well to therapy but progressively becomes refractory

Prevalence • • • • • • •

Emphysema : less frequent Cronic bronchitis : more common US : 6-7 % of Heart failure Delhi : 16% Sheffield in UK : 30 – 40% Autopsy in Chronic Bronchitis : 50% More prevalent in pollution area or smokers

Lab. Findings • X-Ray : Prominent pulmonary hilum pulmonary artery dilatation Rt MPA > 20 mm • EKG : P- pulmonale, RAD, RVH • Echocardiography : RVH, TR, Pulm. Hypertension • ABG : Hypoxemia, Hypercapnea, Respiratory acidosis • CBC : polycythemia • Cardiac catheterization

Treatment • Treat Underlying Disease : COPD Tx, Steroid, Infection control, theophylline, medroxyprogesterone, • Continuous O2 : < 2-3L/min • Diuretics • Phlebotomy • Digoxin : controversial • Pul. Vasodilators • Beta adrenergic agents • Reduce Ventilation/Perfusion imbalance : Amitrine bimesylate

Prognosis • 1960-1970 : 3 yr mortality 50-60% • Recent times : 5 - 10 years or more