Cor Pulmonale

Respiratory (12%) Core Clinical Conditions

1B The Physician Associate is able to identify the condition as a possible diagnosis: may not have the knowledge/resources to confirm the diagnosis or to manage the condition safely, but can take measures to avoid immediate deterioration and refer appropriately

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Definition Aetiology Pathophysiology Risk factor Sign and Symptoms Investigations Management

Definition

Cor pulmonale occurs when the right ventricle is impaired as a result of lung disease. This increases the resistance to blood flow in the pulmonary circulation.

Aetiology

Pulmonary hypertension.
Lung diseases such as COPD, cystic fibroids, emphysema, pneumoconiosis.
Neuromuscular disorders such as myasthenia gravis, multiple sclerosis, motor neurone disease.
Thoracic deformities such as Kyphoscolios.
Scleroderma of the lungs.
Recurrent pulmonary emboli (PE).
Lung cancer.

Pathophysiology

Usually caused by COPD and there is an increased pressure in the pulmonary artery.
It is thought the increased pressure in the pulmonary artery is caused by chronic hypoxia in the pulmonary artery. This causes constriction of the artery to compensate and keep the lungs perfused.
This causes structural changes in the pulmonary arteries ( thickening, narrowing of vessels and increased blood flow resistance).
Right ventricle increased workload > hypertrophy > can lead to heart failure.

Risk factors

COPD.
Recurrent PE.
Obesity.
Sleep apnea.
Sickle cell disease.

Sign and symptoms

Fatigue.
Shortness of breath
Leg swelling.
Dizziness.
O/E: pedal oedema, cyanosis, worked breathing, reduced air entry + crackles and wheeze, raised JVP, murmur, jaundice + ascites (in advanced cases).