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    Cor Pulmonale

    Right-sided heart failure

    Cor pulmonale is failure of the right side of the heart. It isbrought on by long-term high blood pressure in the arteries of the lung and right ventricle of the heart.

    Causes

    High blood pressure in the arteries of the lungs is called pulmonary hypertension. The right side of the heart has a harder time pumping blood to the lungs when this happens. If this high pressure continues, it puts a strain on the right side of the heart, leading to cor pulmonale.

    Any chronic lung condition that causes prolonged low blood oxygen levels can lead to cor pulmonale. A few of these causes include:

    • Chronic obstructive pulmonary disease (COPD)
    • Chronic blood clots in the lungs
    • Cystic fibrosis
    • Scarring of the lung tissue (interstitial lung disease)
    • Severe curving of the upper part of the spine (kyphoscoliosis)
    • Obstructive sleep apnea, in which pauses occur during breathing because of airway inflammation

    Symptoms

    Shortness of breath or light-headedness during activity is often the first symptom. You may have a fast heart beat and feel like your heart is pounding.

    Over time, symptoms occur with lighter activity or even while at rest. They may include:

    • Fainting spells with activity
    • Chest discomfort, usually in the front of the chest
    • Chest pain
    • Swelling of the feet or ankles
    • Symptoms of underlying disorders (wheezing, coughing)

    Exams and Tests

    The health care provider will perform a physical exam. This may reveal:

    • Fluid build up in the belly area (abdomen)
    • Abnormal heart sounds
    • Bluish skin (cyanosis)
    • Liver swelling
    • Swelling (distension) of the neck veins, which is a sign of high right-heart pressures
    • Ankle swelling

    The following tests may help diagnose cor pulmonale:

    • Blood antibody tests
    • Blood test for brain natriuretic peptide (BNP)
    • Chest x-ray
    • CT scan of the chest
    • Echocardiogram
    • Lung biopsy (rarely performed)
    • Measurement of blood oxygen by arterial blood gas (ABG)
    • Pulmonary function tests
    • Right heart catheterization
    • Ventilation and perfusion scan of the lungs (V/Q scan)

    Treatment

    The goal of treatment is to control symptoms. It is important to treat medicalproblems that cause pulmonary hypertension, which can lead to cor pulmonale.

    Many treatment options are available. If you are prescribed medicines, they may may be taken by mouth (oral), received througha vein (intravenous or IV), or breathed in (inhaled).Your doctor will decide which medicine is best for you. You will be closely monitored during treatment to watch for side effects and to see how well the medicine works for you. Never stop taking your medicines without talking to your doctor.

    Other treatments may include:

    • Blood thinners to reduce the risk of blood clots
    • Oxygen thearpy at home
    • A lung or heart-lung transplant, if medication does not work

    Other important tips to follow:

    • Avoid pregnancy
    • Avoid strenuous activities and heavy lifting
    • Avoid traveling to high altitudes
    • Get yearly flu vaccine, as well as other vaccines such as the pneumonia vaccine
    • Stop smoking

    Outlook (Prognosis)

    How well you do depends on what caused the condition.

    As the illness gets worse, you will need to make changes in your home and get help around the house.

    Cor pulmonale may lead to:

    • Life-threatening shortness of breath
    • Severe fluid retention
    • Shock
    • Death

    When to Contact a Medical Professional

    Call your doctor or nurse if you have shortness of breath or chest pain.

    Prevention

    Avoiding behaviors, such as cigarette smoking, whichlead to chronic lung disease, may prevent the development of cor pulmonale.

    References

    McGlothlin D, De Marco T. Cor pulmonale. In: Mason RJ, Broaddus VC, Martin TR, et al., eds. Murray & Nadel's Textbook of Respiratory Medicine. 5th ed. Philadelphia, Pa.: Elsevier Saunders; 2010:chap 56.

    Massie BM. Heart failure: pathophysiology and diagnosis. In: Goldman L, Schafer AI, eds. Goldman’s Cecil Medicine. 24th ed. Philadelphia, Pa.: Elsevier Saunders; 2011:chap 58.

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      A Closer Look

        Tests for Cor Pulmonale

          Review Date: 5/30/2013

          Reviewed By: Denis Hadjiliadis, MD, Assistant Professor of Medicine, Division of Pulmonary, Allergy and Critical Care, University of Pennsylvania, Philadelphia, PA. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Black, Stephanie Slon, and Nissi Wang.

          The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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