Overview

Altered structure (i.e., hypertrophy, dilation) or impaired function of the right ventricle due to pulmonary hypertension resulting from a primary disorder of the respiratory or pulmonary artery system

Cor pulmonale is also known as pulmonary heart disease because it is caused by right ventricular dysfunction resulting from lung disease, not cardiac disease.

• Pathophysiology: a sudden increase in right ventricular afterload results in right ventricular dilation and dysfunction

• Etiology: includes acute massive pulmonary embolism (most common) and ARDS

• Clinical features: acute onset, chest pain, shortness of breath, hypotension, tachycardia, syncope, symptoms of deep vein thrombosis

• Pathophysiology: Increased right ventricular afterload leads to progressive right ventricular hypertrophy that over time results in right ventricular dilation and dysfunction.

• Etiology: caused by diseases of the lung parenchyma and pulmonary vasculature or disorders of chronic hypoxia

  • Lung parenchyma: COPD , interstitial lung disease, bronchiectasis

  • Pulmonary vasculature: PAH, chronic thromboembolic pulmonary hypertension

  • Chronic hypoxia: obesity hypoventilation syndrome, obstructive sleep apnea, kyphoscoliosis, neuromuscular disorders

• Clinical features

  • Similar to clinical features of pulmonary hypertension.

  • Prominent symptoms of right heart failure

• Echocardiogram shows right ventricular dilation, hypertrophy, or dysfunction.

• Further workup depends on the suspected underlying cause;

• For patients with suspected acute cor pulmonale, urgently perform diagnostic studies for PE.

• Treatment depends on the underlying cause

• Patients with acute cor pulmonale typically require:

  • Stabilization

  • Intensive management of the underlying cause