From the Guidelines
Cor pulmonale is a condition characterized by enlargement and failure of the right ventricle of the heart due to increased pressure in the pulmonary circulation, typically resulting from lung disease rather than from primary cardiac causes. This condition occurs when the right ventricle must work harder to pump blood through the lungs against increased resistance in the pulmonary vessels. The most common causes include chronic obstructive pulmonary disease (COPD), pulmonary fibrosis, pulmonary embolism, and sleep apnea, as noted in various studies 1. Patients with cor pulmonale often present with symptoms such as shortness of breath, fatigue, chest pain, and swelling in the legs and abdomen.
Pathophysiology and Causes
The underlying pathophysiology involves hypoxic vasoconstriction, inflammation, and vascular remodeling in the pulmonary arteries, which leads to pulmonary hypertension and subsequently increases the workload on the right ventricle 1. According to the 2018 guidelines for the diagnosis and treatment of pulmonary hypertension, pulmonary hypertension is defined as a mean pulmonary arterial pressure ≥25 mmHg at rest as assessed by right heart catheterization 1.
Diagnosis and Management
Treatment focuses primarily on addressing the underlying lung disease, providing oxygen therapy when needed, and managing symptoms with diuretics to reduce fluid retention. In severe cases, vasodilators may be used to reduce pulmonary pressure, though their effectiveness varies depending on the specific cause of the condition. The management of cor pulmonale requires a comprehensive approach, considering the patient's overall clinical condition and the presence of any comorbidities, as discussed in the context of COPD management 1.
Key Considerations
It is essential to consider the latest guidelines and evidence-based practices when managing cor pulmonale, given its complex pathophysiology and the variety of underlying causes. The 2018 American Heart Association scientific statement on the evaluation and management of right-sided heart failure provides valuable insights into the acute and chronic management of conditions like cor pulmonale 1. By prioritizing the most recent and highest quality evidence, healthcare providers can offer the best possible care for patients with cor pulmonale, aiming to improve morbidity, mortality, and quality of life outcomes.
From the Research
Definition of Cor Pulmonale
- Cor pulmonale is defined as the condition in which the right ventricle undergoes morphological and/or functional changes due to diseases that affect the lungs, the pulmonary circulation, or the breathing process 2.
- It can also be described as right ventricular enlargement secondary to pulmonary hypertension, which can be caused by parenchymal lung disease, derangements of the ventilatory drive, the respiratory pumping mechanism, or the pulmonary vascular bed 3.
- The term "cor pulmonale" is still popular, but there is presently no consensual definition, and it seems more appropriate to define the condition by the presence of pulmonary hypertension (PH) resulting from diseases affecting the structure and/or the function of the lungs 4.
Key Characteristics
- Cor pulmonale is characterized by right ventricular hypertrophy or right ventricular dilatation and/or chronic right heart failure, with many etiologies that largely determine mortality and drug therapy 5.
- The main focus of treatment is to reduce pulmonary vascular pressure and resistance, with the value of correcting hypoxaemia being important, especially in patients with chronic obstructive pulmonary disease (COPD) 4, 5.
- Acute cor pulmonale can be defined as the combination of a paradoxical septal motion, reflecting systolic overload, with right ventricular enlargement, reflecting diastolic overload, and can be caused or exacerbated by an aggressive ventilatory strategy in patients with acute respiratory distress syndrome 6.