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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. Noevidence of other heart conditions, Acute vs. Chronic
Hypercapnea
Acidemia A
Hypoxia
Anatomic changes
Increased C.O.
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
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
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
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
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
Prognosis
1960-1970 : 3 yr mortality 50-60% Recent times : 5 - 10 years or more