What diseases cause the alterations in the structure and function of the right ventricle that is characteristic of cor pulmonale?
Disease of the lung, thorax, or pulmonary circulation
How does the heart adapt to chronic cor pulmonale?
Individual muscle cells grow thicker and adapt to achieve increased contraction required to move blood against greater resistance (right ventricular hypertrophy)
What does "cor" mean in Latin?
What does "pulmonale" mean in Latin?
How does the heart respond to acute cor pulmonale?
Dilation in response to acute increased pressure
What are 2 conditions that can cause acute cor pulmonale?
Pulmonary embolism, ARDS
What is the mechanism of cor pulmonale?
Increased pulmonary vascular resistance --> increased RV afterload, decreased CO --> RV failure
What are the two major causes of cor pulmonale?
Pulmonary vascular changes as a result of tissue damage (PE, chemical agents, disease); Chronic hypoxic pulmonary vasoconstriction (COPD)
What is the most common cause of cor pulmonale?
What are the symptoms of cor pulmonale?
Nonspecific: fatigue, tachypnea, exertional dyspnea, cough, anginal chest pain, hemoptysis, hoarseness
What nonspecific signs may indicate underlying lung disease
Increase in chest diameter, labored respiratory efforts with chest wall retractions, distended neck veins, cyanosis, wheezes or crackles, split S2, systolic ejection murmur with click, S3/S4 with systolic tricuspid regurgitation, pitting edema
What is cor pulmonale the most common cause of?
How is cor pulmonale diagnosed?
Routine labs, CXR, EKG, ECHO, right heart catheterization
What is the most accurate test in the diagnosis of cor pulmonale?
Right heart catheterization
What tests are done to identify underlying lung disease?
Spirometry, CT, V/Q (ventilation/perfusion) scan
How is cor pulmonale secondary to a PE treated?
Anticoagulation or thrombolytics
How is cor pulmonale secondary to COPD treated?
Bronchodilation and management of infection
When is oxygen therapy given in cor pulmonale treatment?
PaO2 < 55mmHg (nml 80-100 mmHg) or O2 sat <88%
What is the 5 year prognosis for a patient with cor pulmonale secondary to COPD?
30% chance of surviving 5 years
What things can cause tissue damage, resulting in the pulmonary vascular changes that are a major underlying pathology of cor pulmonale?
PE, chemical agents, disease
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