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 (pulmonary hypertension) caused by disorders affecting the lungs or their blood vessels. This occurs when the right ventricle must work harder than normal to pump blood through the lungs, leading to structural changes and eventual dysfunction of the right heart. The most common causes include chronic obstructive pulmonary disease (COPD), interstitial lung diseases, sleep apnea, pulmonary embolism, and other conditions that impair lung function or blood flow, as highlighted in the 2018 guidelines for the diagnosis and treatment of pulmonary hypertension 1. Symptoms typically include shortness of breath, fatigue, chest pain, swelling in the legs and abdomen, and decreased exercise tolerance.
Key Points
- The development of cor pulmonale represents advanced disease and indicates significant strain on the cardiopulmonary system, making early detection and management of the underlying lung condition crucial for preventing progression to right heart failure.
- Treatment focuses on addressing the underlying lung condition, which may involve bronchodilators, oxygen therapy, diuretics to reduce fluid retention, and in some cases, pulmonary vasodilators, as discussed in the evaluation and management of right-sided heart failure 1.
- The condition is often associated with increased pulmonary vascular resistance, which can lead to right ventricular failure, as noted in the study on clinical exercise testing with reference to lung diseases 1.
- Early detection and management of cor pulmonale are critical to prevent morbidity, mortality, and to improve quality of life, as emphasized in the 2018 GOLD report on COPD guidelines 1.
Management and Treatment
The management of cor pulmonale involves a multidisciplinary approach, including the use of vasopressors, inotropic agents, and pulmonary vasodilators, as recommended in the guidelines for the diagnosis and treatment of pulmonary hypertension 1. Additionally, addressing the underlying lung condition, such as COPD, is crucial in preventing the progression of cor pulmonale, as highlighted in the 2018 GOLD report 1.
Conclusion is not allowed, so the response ends here.
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.