Cor Pulmonale-Diseases

What is this condition? A chronic heart condition, cor pulmonale is an enlargement of the right ventricle that results from various lung diseases, except those that primarily affect the left side of the heart, or congenital heart disease. Invariably, cor pulmonale follows some disorder of the lungs, pulmonary vessels, chest wall, or respiratory control center. For instance, chronic obstructive pulmonary disease produces pulmonary hypertension, which leads to right ventricular enlargement and failure. Because cor pulmonale generally occurs late during the course of chronic obstructive pulmonary disease and other irreversible diseases, the prognosis is generally poor. What causes it? Approximately 85% of people with cor pulmonale have chronic obstructive pulmonary disease. And 25% of people with chronic obstructive pulmonary disease eventually develop cor pulmonale. Other respiratory disorders that produce cor pulmonale include: " obstructive lung diseases, such as bronchiectasis and cystic fibrosis " restrictive lung diseases, such as black lung and scleroderma " loss of lung tissue after extensive lung surgery " diseases of the lungs' blood vessels " respiratory insufficiency without lung disease, as seen in muscular dystrophy and amyotrophic lateral sclerosis " obesity hypoventilation syndrome (pickwickian syndrome) and upper airway obstruction " living at high altitudes (chronic mountain sickness). To compensate for the extra work needed to force blood through the lungs, the right ventricle dilates and enlarges. Eventually, this leads to right ventricular failure. Cor pulmonale accounts for about 25% of all types of heart failure. Cor pulmonale is most common in areas of the world where the incidence of cigarette smoking and chronic obstructive pulmonary disease is high; it affects middle-aged to elderly men more often than women, but incidence in women is increasing. In children, cor pulmonale may be a complication of cystic fibrosis, upper airway obstruction, scleroderma, extensive bronchiectasis, or other disorders. What are its symptoms? At first, symptoms reflect the underlying disorder and occur mostly in the respiratory system. They include chronic cough, shortness of breath on exertion, wheezing respirations, fatigue, and weakness. As the disease progresses, symptoms include shortness of breath (even at rest) that worsens on exertion, rapid breathing, swelling, weakness, and discomfort in the right upper abdomen. A chest exam reveals findings characteristic of the underlying lung disease. Drowsiness and alterations in consciousness may occur. How is it diagnosed? Pulmonary artery pressure measurements show increased right ventricular and pulmonary artery pressures as a result of increased pulmonary vascular resistance. Other useful diagnostic tests include echo cardiography (ultrasound of the heart) or angiography, a chest X-ray, arterial blood gas analysis, electrocardiography, pulmonary function tests, and hematocrit. How is it treated? Treatment of cor pulmonale is designed to reduce oxygen deficiency, increase the persons exercise tolerance, and, when possible, correct the underlying condition.In addition to bed rest, treatment may include administration of: " digitalis glycosides (such as Lanoxin) " antibiotics when respiratory infection is present " potent pulmonary artery vasodilators (such as Hyperstat, Nipride, Aresoline, angiotensin-converting enzyme inhibitors, calcium channel blockers, or prostaglandins) in primary pulmonary hypertension " oxygen by mask or, in acute cases, by a mechanical ventilator " low-salt diet, restricted fluid intake, and diuretics, such as Lasix, to reduce swelling " phlebotomy to reduce the red blood cell count " anticoagulation with small doses of Calciparine to reduce the risk of thromboembolism.