Cor Pulmonale: Causes

Pathogenesis (development of disease)

Cor pulmonale acutum develops acutely from pulmonary embolism or from an attack in the setting of bronchial asthma. Cor pulmonale chronicum develops from pulmonary hypertension (pulmonary hypertension), which is caused by changes in the pulmonary vessels or lung tissue.

Etiology (causes) of cor pulmonale acutum

Disease-related causes

Respiratory System (J00-J99)

  • Status asthmaticus – potentially life-threatening form of asthma attack.
  • Tension pneumothorax – life-threatening form of “gas chest”; this involves the development of excess pressure in addition to collapsed lungs

Cardiovascular system (I00-I99)

Other causes

  • Surgery on the thorax (chest)

Etiology (causes) of cor pulmonale chronicum

Biographic causes

  • Genetic burden
    • Genetic diseases
      • Sickle cell anemia (med: drepanocytosis; also sickle cell anemia, English : sickle cell anemia) – genetic disorder with autosomal recessive inheritance affecting erythrocytes (red blood cells); it belongs to the group of hemoglobinopathies (disorders of hemoglobin; formation of an irregular hemoglobin called sickle cell hemoglobin, HbS).
      • Cystic fibrosis (CF) – genetic disease with autosomal recessive inheritance, characterized by the production of too tame secretion in various organs.

Behavioral causes

Disease-related causes

Respiratory system (J00-J99)

  • Anthracosis (pathologic change in the lungs caused by inhalation and storage of soot or charcoal particles).
  • Bronchial asthma
  • Bronchiectasis (synonym: bronchiectasis) – persistent irreversible saccular or cylindrical dilatation of the bronchi (medium-sized airways), which may be congenital or acquired; symptoms: chronic cough with “mouthful expectoration” (large-volume triple-layered sputum: foam, mucus, and pus), fatigue, weight loss, and a decreased ability to perform
  • Chronic bronchitis
  • Chronic obstructive pulmonary disease (COPD)
  • Idiopathic pulmonary fibrosis – connective tissue remodeling of the lungs leading to functional impairment.
  • Pulmonary emphysema (irreversible hyperinflation of the smallest air-filled structures (alveoli, alveoli) of the lungs).
  • Pleural nipples (thickening of the pleura (pleura), which can lead to a limitation of lung capacity)
  • Pneumoconiosis (pneumoconiosis)
  • Sarcoidosis – inflammatory systemic disease affecting mainly the lungs, lymph nodes and skin.
  • Silicosis (quartz lung)
  • Tracheal stenosis (narrowing of the trachea)
  • Tuberculosis (consumption)

Blood, blood-forming organs – immune system (D50-D90).

  • Anemia (anemia)
  • Autoimmune disease with vasculitis (inflammation of blood vessels), unspecified

Endocrine, nutritional and metabolic diseases (E00-E90).

  • Obesity (adiposity) – leads to chronic hypoventilation (restricted lung ventilation) and thus to chronic cor pulmonale
  • Pickwick syndrome – syndrome with obesity (obesity), unclear sleep conditions, pulmonary hypertension, etc.

Cardiovascular system (I00-I99)

  • Valvular heart disease (vitiation), unspecified.
  • Cardiomyopathy – heart muscle disease leading to impaired cardiac function.
  • Coronary artery disease (CAD) – disease of the coronary arteries.
  • Myocardial infarction (heart attack)
  • Pericarditis constrictiva – chronic pericarditis with shrinkage of the pericardium and consequent limitation of cardiac function.
  • Primary pulmonary hypertension – pulmonary hypertension without apparent cause.
  • Endangiitis obliterans – segmental vasculitis (vascular inflammation) of small and medium-sized arteries and veins predominantly of the lower extremity.
  • Periarteritis nodosa – necrotizing vasculitis (vascular inflammation), which usually affects medium-sized vessels.
  • Pulmonary hypertension – high blood pressure due to pulmonary (vascular) disease.
  • Pulmonary sclerosis – connective tissue remodeling of the vascular wall of the pulmonary artery and its branches leading to hardening (sclerosis).
  • Venous occlusive disease, unspecified
  • Condition following multiple pulmonary artery embolism – occlusion of one or more pulmonary vessels by a thrombus (blood clot), usually due to venous thrombosis

Liver, gallbladder, and bile ducts – pancreas (pancreas) (K70-K77; K80-K87).

  • Cystic pancreatic fibrosis – connective tissue remodeling of the pancreas secondary to pulmonary afflictions.

Musculoskeletal system and connective tissue (M00-M99).

  • Granulomatosis with polyangiitis (GPA), formerly Wegener’s granulomatosis – necrotizing (tissue dying) vasculitis (vascular inflammation) of the small to medium-sized vessels (small-vessel vasculitides), which is associated with granuloma formation (nodule formation) in the upper respiratory tract (nose, sinuses, middle ear, oropharynx) as well as the lower respiratory tract (lungs)
  • Kyphoscoliosis – simultaneous occurrence of a sideways shift with a backward curvature of the spine; can lead to chronic cor pulmonale (cor kyphoskolioticum) via chronic hypoventilation.
  • Bekhterev’s disease (synonym: ankylosing spondylitis) – chronic inflammatory disease of the spine, which can lead to joint stiffness (ankylosis) of the affected joints.
  • Rib deformities
  • Scleroderma – group of autoimmune connective tissue diseases that is one of the collagenoses.
  • Vascular collagen diseases, unspecified – cause occlusion of the pulmonary vascular bed.

Neoplasms – tumor diseases (C00-D48).

  • Bronchus adenoma – benign neoplasm on one bronchus.
  • Bronchial carcinoma (lung cancer)
  • Lymphangiosis carcinomatosa – spread of a malignant tumor in the lymphatic vessels.
  • Tumors of the mediastinum (mediastinal cavity).
  • Tumors of the trachea – neoplasm of the trachea.

Psyche – nervous system (F00-F99; G00-G99)

  • Amyotrophic lateral sclerosis (ALS; synonyms: Myatrophic Lateral Sclerosis or Motor Neuron Disease and Lou Gehrig’s Syndrome) – degenerative disease of the motor nervous system; progressive and irreversible damage or degeneration of nerve cells (neurons) occurs. The degeneration leads to increasing muscle weakness ( paresis/paralysis), which is accompanied by muscle wasting (amyotrophy).
  • Muscular dystrophy (muscle weakness), unspecified.
  • Myasthenia gravis (MG; synonyms: myasthenia gravis pseudoparalytica; MG); rare neurological autoimmune disease in which specific antibodies against the acetylcholine receptors are present, with characteristic symptoms such as abnormal load-dependent and painless muscle weakness, asymmetry, in addition to local also a temporal variability (fluctuation) in the course of hours, days, resp. Weeks, an improvement after recovery or rest periods; clinically can be differentiated a purely ocular (“concerning the eye”), a faciopharyngeal (face (Facies) and pharynx (pharynx) concerning) emphasized and a generalized myasthenia; about 10% of cases already show a manifestation in childhood.
  • Neuromuscular diseases – lead to chronic hypoventilation and thus chronic cor pulmonale.

Other causes

  • Condition after lung (partial) resection (lung (partial) removal).
  • Dysfunction of the thoracic wall – leads to chronic cor pulmonale via chronic hypoventilation.