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Cor Pulmonale

Cor Pulmonale. Sung Chul Hwang, M.D. Dept. of Pulmonary and Critical Care Medicine Ajou University School of Medicine. Cor Pulmonale. Right Sided Heart Disease, secondarily caused by abnormalities of lung parenchyme, airways, thorax, or respiratory control mechanisms.

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Cor Pulmonale

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  1. CorPulmonale Sung Chul Hwang, M.D. Dept. of Pulmonary and Critical Care Medicine Ajou University School of Medicine

  2. Cor Pulmonale • Right Sided Heart Disease,secondarily caused by abnormalities of lung parenchyme, airways, thorax, or respiratory control mechanisms. • Noevidence of other heart conditions, • Acute vs. Chronic

  3. Lung and Airways COPD Asthma Bronchiectasis DILD Pulmonary tuberculosis Vascular Occlusion Multiple Emboli Schistosomiasis Filariasis Sickle Cell P. Pulmonary Hypertension Etiology of Cor Pulmonale ( I )

  4. Thoracic Cage Kyphosis > 100 o Scoliosis > 120 o Thoracoplasty Pleural fibrosis N-M Disease Polio Myelitis Myasthenia Gravis ALS Muscular Dystrophy Etiology of Cor Pulmonale ( II )

  5. Etiology of Cor Pulmonale ( III ) Abnormal Respiratory Control • Idiopathic hypoventilation Syndrome • Obesity hypoventilation syndrome (Pick-Wickian syndrome) • Cerebrovascular disease

  6. Hypercapnea H Anatomic changes Hypoxia Acidemia A Pulmonary Vessel Restriction Increased Viscosity Increased C.O. C Acidosis Chronic Cor Pulmonale Rt. Ventricular Failure

  7. Pathologic Features • Lung : consistent with Specific diseases • Common Features: hypertrophy of microvasculatures • Hallmark : Rt. Ventricular Hypertrophy 60g – 200g, > 0.5 CM, RV/LV <2.5 • Lt. Ventricular Hypertrophy • Hypertrophy of Carotid Body

  8. Natural History • Several months to years to develop • All ages from child to old people • Repeated infections aggravate RV strain into RV failure • Initilly respondes well to therapy but progressively becomes refractory

  9. Prevalence • Emphysema : less frequent • Cronic bronchitis : more common • US : 6-7 % of Heart failure • Delhi : 16% • Sheffield in UK : 30 – 40% • Autopsy in Chronic Bronchitis : 50% • More prevalent in pollution area or smokers

  10. Lab. Findings • X-Ray : Prominent pulmonary hilum pulmonary artery dilatation Rt MPA > 20 mm • EKG : P- pulmonale, RAD, RVH • Echocardiography : RVH, TR, Pulm. Hypertension • ABG : Hypoxemia, Hypercapnea, Respiratory acidosis • CBC : polycythemia • Cardiac catheterization

  11. Treatment • Treat Underlying Disease : COPD Tx, Steroid, Infection control, theophylline, medroxyprogesterone, • Continuous O2 : < 2-3L/min • Diuretics • Phlebotomy • Digoxin : controversial • Pul. Vasodilators • Beta adrenergic agents • Reduce Ventilation/Perfusion imbalance : Amitrine bimesylate

  12. Prognosis • 1960-1970 : 3 yr mortality 50-60% • Recent times : 5 - 10 years or more

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