Cor pulmonale
Updates to Article Attributes
Cor pulmonale is defined as a failure of the structure and function of the right ventricle in the absence of left ventricular dysfunction. It is caused by an underlying primary disorder of the respiratory system. It has a generally chronic and slowly progressive course, although acute onset or worsening with life-threatening complications can occur.
Clinical presentation
ECG
-
dominant R wave in lead V1 10
defined as an R wave height > 7 mm or R/S > 1
accompanied by dominant S waves in lead V6
right axis deviation
-
secondary
repolarizationrepolarisation abnormalitiessimultaneous involvement of the right precordium (V1-4) and inferior limb leads (II, III, aVF)
depressed ST segments with T wave inversion
Pathology
The pulmonary vascular resistance, under normal circumstances, is one tenth that of the systemic arteries. Lung parenchymal changes (e.g COPD, fibrosis) resulting in chronic hypoxaemia stimulates smooth muscle proliferation within the pulmonary arteries, which in turn increases the pulmonary vascular resistance. This increases the strain on the right ventricle which has to pump against a greater pressure, resulting in its dilatation/hypertrophy.11
Aetiology
massive pulmonary emboli: for acute cor pulmonale
acute respiratory distress syndrome: for acute cor pulmonale
Radiographic features
Plain radiograph
central pulmonary artery enlargement 7
changes consistent with the underlying pulmonary disease as outlined above
Echocardiography
May show dilatation of the left ventricular cavity or thickening of the right ventricular free wall 6.
Treatment and prognosis
Cor pulmonale generally carries a poor prognosis. Long-term oxygen therapy is often considered the main treatment option.
History and etymology
From the Latin, cor: 'heart', and pulmonale, 'relating to the lungs', ultimately from the Latin pulmo meaning 'lung'. Therefore 'heart secondary to / relating to the lungs'.
See also
-<li>dominant R wave in lead V1 <sup>10</sup><ul>-<li>defined as an R wave height > 7 mm or R/S > 1</li>-<li>accompanied by dominant S waves in lead V6</li>- +<li>
- +<p>dominant R wave in lead V1 <sup>10</sup></p>
- +<ul>
- +<li><p>defined as an R wave height > 7 mm or R/S > 1</p></li>
- +<li><p>accompanied by dominant S waves in lead V6</p></li>
-<li>right axis deviation</li>-<li>secondary repolarization abnormalities<ul>-<li>simultaneous involvement of the right precordium (V1-4) and inferior limb leads (II, III, aVF)</li>-<li>depressed ST segments with T wave inversion</li>- +<li><p>right axis deviation</p></li>
- +<li>
- +<p>secondary repolarisation abnormalities</p>
- +<ul>
- +<li><p>simultaneous involvement of the right precordium (V1-4) and inferior limb leads (II, III, aVF)</p></li>
- +<li><p>depressed ST segments with T wave inversion</p></li>
-<li><a href="/articles/right-atrial-enlargement">right atrial enlargement</a></li>-</ul><h4>Pathology</h4><h5>Aetiology</h5><ul>-<li><a href="/articles/chronic-obstructive-pulmonary-disease-1">chronic obstructive pulmonary disease</a></li>-<li><a href="/articles/cystic-fibrosis-pulmonary-manifestations-1">pulmonary manifestations of cystic fibrosis</a></li>-<li><a href="/articles/interstitial-lung-disease">interstitial lung disease</a></li>-<li>massive <a href="/articles/pulmonary-embolism">pulmonary emboli</a>: for acute cor pulmonale<sup> </sup>-</li>-<li>-<a href="/articles/acute-respiratory-distress-syndrome-1">acute respiratory distress syndrome</a>: for acute cor pulmonale</li>-<li><a title="Pulmonary sarcoidosis" href="/articles/sarcoidosis-thoracic-manifestations-2">pulmonary sarcoidosis</a></li>- +<li><p><a href="/articles/right-atrial-enlargement">right atrial enlargement</a></p></li>
- +</ul><h4>Pathology</h4><ul><li><p>The pulmonary vascular resistance, under normal circumstances, is one tenth that of the systemic arteries. Lung parenchymal changes (e.g COPD, fibrosis) resulting in chronic hypoxaemia stimulates smooth muscle proliferation within the pulmonary arteries, which in turn increases the pulmonary vascular resistance. This increases the strain on the right ventricle which has to pump against a greater pressure, resulting in its dilatation/hypertrophy.<sup>11</sup></p></li></ul><h5>Aetiology</h5><ul>
- +<li><p><a href="/articles/chronic-obstructive-pulmonary-disease-1">chronic obstructive pulmonary disease</a></p></li>
- +<li><p><a href="/articles/cystic-fibrosis-pulmonary-manifestations-1">pulmonary manifestations of cystic fibrosis</a></p></li>
- +<li><p><a href="/articles/interstitial-lung-disease">interstitial lung disease</a></p></li>
- +<li><p>massive <a href="/articles/pulmonary-embolism">pulmonary emboli</a>: for acute cor pulmonale</p></li>
- +<li><p><a href="/articles/acute-respiratory-distress-syndrome-1">acute respiratory distress syndrome</a>: for acute cor pulmonale</p></li>
- +<li><p><a href="/articles/sarcoidosis-thoracic-manifestations-2" title="Pulmonary sarcoidosis">pulmonary sarcoidosis</a></p></li>
-<li>central pulmonary artery enlargement <sup>7</sup>-</li>-<li>changes consistent with the underlying pulmonary disease as outlined above</li>- +<li><p>central pulmonary artery enlargement <sup>7</sup></p></li>
- +<li><p>changes consistent with the underlying pulmonary disease as outlined above</p></li>
-<li><a href="/articles/right-heart-failure">right heart failure</a></li>-<li><a href="/articles/right-heart-strain">right heart strain</a></li>- +<li><p><a href="/articles/right-heart-failure">right heart failure</a></p></li>
- +<li><p><a href="/articles/right-heart-strain">right heart strain</a></p></li>
References changed:
- 11. Garrison DM, Pendela VS, Memon J. Cor Pulmonale. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 Mar 26]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK430739/
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