cor pulmonale

sings of cor pulmonale

Anorexia right upper quadrant pain,jaundice →hepatic congestion secondary to severe RV failure Peripheral edema : increased pulmonary arterial pressure can leads to increased right atrial,pseripheral and capillary pressure Right ventricular hypertrophy:parasternal heave Rigthventricular failure : hepatojugular reflus and pulsatile liver Increased chest diameter,laboured respiratory and distended neck veins cyanosis ausculatition: wheezes and crackles Splitting of S2 and systolic ejection murmur with sharp click (location of pulmonary arteery)

ingestivations of corpulmonale

Pulmonary function test lab arterial blood gas chest x ray ecg eho

chronic cor pulmonale

Right ventriculra HYPERTROPHY is predominant -Interstitial lung disease:COPD,bronchiectasis,CF -connective tissue disease -increased blood viscosity: polycythemia vera,sickle cell disease,macroglobulinemia -idiopathic primary pulmonary hypertension -neuromuscular and skeletal muscle disease

etiology of cor pulmonale?

acute chronic

digoxin

administer cautiously : toxicity increased due to hypoxemia,hypercapnia,acidosis

echo

chronic right ventricle overload RV thickness and paradoxical interventricular septum moton during systole estimate pulmoarny artery pressure

alteration in the structure and function of the right ventricle caused by a primary disorder of the RESPIRATORY system! Pulmonary hypertension is the common link between lung dysfunction and the heart in cor pulmonale!! Prognosis is poor! 50% die within 5 years

describe cor pulmonale

chest x ray

enlargement of central pulmonary arteryr

symtpoms of cor pulmonale

excertional dyspnea tachypnea fatigue cough syncope angina like chest pain may occur hemoptysis (ruptured of dilated or atherosclerotic pulmonary artery) clubbing

lab:

hematocrit: look for polycythemia serum alpha 1 antitripsin ANA for collagen vascular disease Coagulation studies

pathophysiology of cor pulmonale

increase in pulmonary arterial pressure (for whatever reason),either acute or chronic affects the RV. RV output: RV is is a thin walled chamber,more a volume pump than a pressure pump. increased pulmomary arterial pressure results in rv dilation. Leads to incerae in RV end-diastolic pressure and right ventricular circulatory collapse. this again affects the left ventricle which will have a decreaed LV preload (enddiastolic volume) and left ventricular output. RV overload: leads to displacement of the septum into the LV.decreases lv volume and output.

arterial blood gas

level of oxygenation and type of ABB disorder

acute cor pulmonale

mainly acute RV dilation occurs due to Pulmonary embolism; sudden increase in pulmonary resistance ARDS acute respiratory distress syndrome!→mechanical ventilation and pathological features of the disease cause RIGHT VENTRICLE OVERLOAD

ECG

right axis deviation P wave amplitude increases in lead 2,3, avf Low voltage qrs due to ynderlying COPD hyperinflation

basically cor pulmonale is?

right heart failure due to pulmonary hypetrtension!

Define cor pulmonale

right heart failure, an enlargement of the right ventricle due to high blood pressure in the arteries of the lungs,usually caused by chronic lung disease

treatment of cor pulmonale

treat underlying pulmonary disease bronchodilators,atb , 02 administration RV failure: treat as congestive heart fialure: Low sodium diet and diuretics Digoxin Loop diuretics chronic anticoagulation: Warfarin is indicated when pulmonary hypertension is accompanied by RV failure Supraventricular tachyarrhytmia: digoxin or verepamil