Cor Pulmonale

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Introduction

Cor pulmonale, also known as pulmonary hypertensive heart disease, is characterized by right ventricular hypertrophy, dilation, and potential failure. It is caused by pulmonary hypertension, which follows a variety of disorders.

The Case of...

a simple case introducing clincial presentation and calling for a differential diagnosis to get students thinking.

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Causes and Risk Factors

Diseases of the lung parenchyma

chronic obstructive pulmonary disease
diffuse pulmonary interstitial fibrosis
pneumonoconiosis
cystic fibrosis
bronchiectasis

Diseases of pulmonary vessels

recurrent pulmonary embolism
primary pulmonary hypertension
pulmonary arteritis (ie Wagner's granulomatosis)
drug-, toxin-, or radiation-induced vascular obstruction
extensive tumour microembolism

Disorders affecting chest movement

kyphoscolioisis
marked obesity
neuromuscular diseases

Disorders inducing pulmonary arterial constriction

metabolic acidosis
hypoxemia
chronic altitiude sickness
major airway obstruction
idiopathic alveolar hypoventilation

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Pathophysiology

used with permission, wikimedia

The right ventricular dilation following left-sided failure or congenital problems is similar to that of cor pulmonale.

Cor pulmonale can be acute or chronic.

Acute cor pulmonale can follow a massive pulmonary embolism. Marked dilation occurs without hypertrophy.

Chronic cor pulmonale suggests prolonged pressure overload caused by obstruction of pulmonary arteries or arterioles or by destruction of septal capillaries. The right ventricular wall thickens and my even begin to approximate the left ventricle.

Secondary compression of the left ventricular chamber or tricuspid regurgitation can follow fibrous thickening of the valve.

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