KHARKIV NATIONAL MEDICAL

UNIVERSITY .
Department of Internal Medicine N:2

Cardiovascular Diseases:
COR PULMONALE
Teacher : Анна Олегівна Сипало
Student : Badad Ibtissame
Faculty : 06 , Group : 20 .
5th Course , GM .
 Table of contents
01 02 03
Recall Introduction Definition
A quick anatomy and Detailed definition of the
General infromation
physiology reminder disease

04 05 06
Classification Etiology Pathophysiology
Forms of the disease What causes Cor Pulmonale ? How Core Pulmonale Develops
?
 Table of contents
07 08 09
Signs and symptoms Diagnosis Treatment

10 11 12
Differential Prognosis Recap
Diagnosis
 01
Recall
Recall :
 02
Introdction
 Introduction
COR PULMONALE

Heart Lung
Dysfunction Dysfunction
 03
Definition
 03
The disease
 Cor pulmonale can be defined as an alteration in the structure (e.g.,
hypertrophy or dilatation) and function of the right ventricle (RV) of the
heart caused by a primary disorder of the respiratory system resulting in
pulmonary hypertension. Right-sided heart failure secondary to left-sided
heart failure, or congenital heart disease is not considered cor pulmonale.
 04
Classification
Classification of Cor Pulmonale :

Acute : Chronic :

acute right heart strain or right ventricular

overload resulted from hypertrophy and or
pulmonary hypertension dilatation secondary to
which usually follows a pulmonary hypertension
massive pulmonary which is due to disease of
embolus . the lung parenchyma or
pulmonary vascular
system
 05
Etiology
Etiology :
 06
Pathophysiology
Pathophysiology of Cor Pulmonale :
Pathophysiology of Cor Pulmonale :
● The pathophysiology of cor pulmonale is a result of increased right-sided filling pressures from
pulmonary hypertension that is associated with diseases of the lung.
● Under normal physiologic conditions, the right ventricle pumps against a low-resistance circuit.
● Normal pulmonary vascular resistance is approximately one-tenth of the resistance of the systemic
arteries. Chronic hypoxemia leading to chronic vasoconstriction produces smooth muscle
proliferation in small pulmonary arteries. Hypoxemia produces changes in vascular mediators such as
Nitric Oxide, Endothelin1 (ET1) and platelet-derived growth factors (PDGF A and B). Nitric oxide is
a vasodilator; hypoxemia reduces endothelial cell production of nitric oxide and results in impaired
smooth ms relaxation.
● The initial pathophysiologic event in the production of cor pulmonale is an elevation of pulmonary
vascular resistance. As the resistance increases, the pulmonary arterial pressure rises, and the right
ventricular work increases leading to right ventricular enlargement (e.g., thickening, dilation, or both).
 07
Signs and
symptoms
 Symptoms of the disease
Fatigue lethargy,
Chest Pain .
exertional syncope .

Abdominal edema or
distension Shortness breath
dyspnea on exertion
most common .
Lower extremity
edema.
 History and Physical findings:
● The clinical signs occur late, being observed at an advanced stage of the
disease far after the development of pulmonary hypertension.
● Physical findings may include: 
• Jugular venous distension: Prominent jugular V wave, indicating the
presence of tricuspid regurgitation
• Cardiovascular: Palpable left the parasternal lift, loud S2 (accentuation of
the pulmonary component of the second heart sound) narrow splitting of
S2, a holosystolic murmur of tricuspid regurgitation at the left lower
sternal border, right-sided S4 heart sound
• Abdomen: Hepatomegaly, ascites.
 History and Physical findings:
● Peripheral (ankle) edema: The best sign of RHF, but it is not
specific and can arise from other causes
● On auscultation of the lungs, wheezes and crackles may be
heard as signs of underlying lung disease. Turbulent flow
through recanalized vessels in chronic thromboembolic
pulmonary hypertension [9] may be heard as systolic bruits in
the lungs. On percussion, hyperresonance of the lungs may be
a sign of underlying COPD.
 08
Diagnosis
 Diagnosis

Routine Laboratory Right ❤ Electrocardiography

test Catheterization and
Echocardiography

Lung Pathology Chest Radiography Cardiac Magnetic

Investigation Resonance
 Diagnosis :
Laboratory investigations are directed toward defining the potential
underlying etiologies as well as evaluating the complications of cor
pulmonale. In specific instances, appropriate laboratory studies may
include the following:
Hematocrit for polycythemia, which can be a consequence of underlying
lung disease but can also increase pulmonary arterial pressure by
increasing viscosity
Serum alpha1-antitrypsin, if deficiency is suspected
Antinuclear antibody (ANA) level for collagen vascular disease, and
anti-SCL-70 antibodies in scleroderma
Coagulations studies to evaluate hypercoagulability states (eg, serum
levels of proteins S and C, antithrombin III, factor V Leyden,
anticardiolipin antibodies, homocysteine)
 Diagnosis :
● Laboratory investigations are directed toward defining the
potential underlying etiologies as well as evaluating the
complications of cor pulmonale These include:
• Chest radiograph: Enlargement of the pulmonary artery may
be seen, cardiomegaly is confined predominantly, if not
exclusively, to the right ventricle and other features may be
detected according to the cause
• Electrocardiogram: Shows features of right ventricular
hypertrophy/enlargement
• Doppler echocardiography (most practical but heavily operator
dependent): The non-invasive diagnosis of pulmonary
hypertension is presently based on echocardiography.
Continuous-wave Doppler echocardiography allows the
calculation of the trans tricuspid pressure gradient from the
peak velocity of the tricuspid regurgitant jet
Echocardiography Electrocardiogram
 Diagnosis :
• Chest CT angiography to rule out pulmonary thromboembolism
as a cause. Main pulmonary artery diameter measurements
greater than 29 mm have a sensitivity of 84% and specificity of
75% for the diagnosis of pulmonary hypertension
• Ventilation/perfusion (V/Q) scanning can be particularly useful in
evaluating patients with cor pulmonale, especially if pulmonary
hypertension is due to chronic thromboembolic pulmonary
hypertension (CTEPH)
• MRI: This noninvasive technique yields highly accurate
dimensions of the right ventricle but is not routinely used
 Diagnosis :
• PFTs and 6-minute walk test for assessment of the severity of
lung disease and exercise capacity respectively
• A right heart cath is a gold standard for diagnosis, assessment
of Pulmonary hypertension severity. Right heart catheterization
reveals evidence of right ventricular (RV) dysfunction (mean
pulmonary artery pressure (PAP) above 25 mmHg) without left
ventricular (LV) dysfunction. Differentiating left-sided from the
right-sided disease includes measuring the pulmonary capillary
wedge pressure (PCWP), which is an estimation of left atrial
pressure. Thus, RV dysfunction is also defined as having a
PCWP below 15 mmHg.
 09
Treatment
 Treatment :
● Treatment / Management
● Treatment is aimed primarily at treating the underlying
condition; the aim is improving oxygenation and right
ventricular (RV) function by increasing RV contractility and
decreasing pulmonary vasoconstriction.
● Oxygen therapy relieves hypoxemic pulmonary
vasoconstriction, which then improves cardiac output, lessens
sympathetic vasoconstriction, alleviates tissue hypoxemia, and
improves renal perfusion.
 Treatment :
● Treatment / Management
● Diuretics are used to decrease the elevated right ventricular
(RV) filling volume in patients with chronic cor pulmonale.
● The use of cardiac glycosides, such as digitalis in patients with
cor pulmonale has been controversial, and the beneficial effect
of these drugs is not as obvious as in the setting of left heart
failure. Nevertheless, studies have confirmed a modest effect of
digitalis on the failing right ventricle in patients with chronic
cor pulmonale.
 10
Differential
Diagnosis
 Differential Diagnosis
• Atrial myxoma
• Blood disorders that are associated with increased blood
viscosity
• Chronic thromboembolic pulmonary hypertension
• Congestive (biventricular) heart failure
• Constrictive pericarditis
Differential Diagnosis
• High-output heart failure
• Infiltrative cardiomyopathies
• Interstitial lung disease (ILD)
• Obstructive sleep apnea (OSA)
• Primary pulmonic stenosis
• Pulmonary hypertension
• Right heart failure due to congenital heart
diseases
• Right heart failure due to right ventricular
infarction
• Ventricular septal defect
 11
Prognosis
 Prognosis
● The prognosis of cor pulmonale is variable-dependant upon the
underlying pathology. The development of cor pulmonale as a result
of a primary pulmonary disease usually heralds a poorer prognosis.
● Highlights:
• Cor pulmonale is right ventricular dysfunction from long-
standing pulmonary HTN.
• All primary lung diseases can cause PHTN and thus cor pulmonale.
• Dyspnea on exertion is the most common symptom.
• Primarily, treatment aims to treat the underlying condition.
 12
Recap
 Recap
Cor pulmonale is right heart hypertrophy, dysfunction or failure caused
by pulmonary hypertension from a lung condition.This results in systemic
fluid congestion leading to jugular venous distension, hepatomegaly, and
edema.After diagnosis with echocardiography, right heart catheterization
and potentially spirometry, treatment includes addressing the underlying
lung condition and administering supplemental oxygen .
 Resources
● https://www.ncbi.nlm.nih.gov/books/NBK430739/
● https://www.youtube.com/watch?
v=GGkajjvMEAQ&ab_channel=ZeroToFinals
● https://www.msdmanuals.com/professional/cardiovascular-disorders/h
eart-failure/cor-pulmonale?query=cor%20pulmonale
● https://emedicine.medscape.com/article/154062-overview#a20
Thanks for
Your
Attention!