Cor pulmonale is the term used to describe enlargement of the right heart due to pressure from lung disease. A distinction is made between an acute and a chronic form. The main symptoms are exercise-induced shortness of breath and lack of exercise capacity.
What is cor pulmonale?
The term cor pulmonale comes from Latin and means “heart of the lung.” An increase in pressure in the lungs causes high blood pressure in the pulmonary circulation. The result is a pressure load on the right heart, more specifically the right ventricle. This results in enlargement and expansion of the right heart and ultimately in heart failure of the right heart, i.e., cardiac insufficiency.
Cause
The cause of cor pulmonale is increased resistance in the pulmonary circulation, against which the right heart must pump. Acute cor pulmonale is usually caused by a pulmonary embolism. In a pulmonary embolism, an artery in the lung becomes blocked by a blood clot (thrombus). This is usually a thrombus from the veins of the leg or pelvis. If a large pulmonary artery is completely blocked by the thrombus, blood can no longer flow through this vessel, resulting in blood stasis. This happens not only in the occluded artery, but also in the remaining pulmonary arteries. Although these are actually functional, they are used as “escape routes” for the blocked artery, so to speak, and are thus overused. As a result, blood backs up to the right heart. An asthma attack or a pneumothorax, i.e. the collapse of a lung lobe, can also cause acute cor pulmonale. Chronic cor pulmonale develops much more slowly. The most common cause here is chronic obstructive pulmonary disease (COPD). Chronic obstructive pulmonary disease refers to various diseases characterized by cough with sputum and shortness of breath. A typical COPD is chronic bronchitis, a chronic inflammation of the bronchial tubes, which mainly affects long-time smokers. The inflammatory processes in the lungs cause the pulmonary vessels to become severely constricted. This again leads to an increase in pressure in the pulmonary circulation and thus also to a strain on the right heart.
Symptoms, complaints, and signs
The symptoms of cor pulmonale must again be distinguished between the acute and chronic forms. Acute cor pulmonale develops very rapidly. There is a sudden onset of severe shortness of breath. Without treatment, the right heart fails within a very short time. The result is sudden cardiac death. Chronic cor pulmonale develops over years. As the right heart becomes weaker and weaker due to the pressure load, it can no longer adequately pump venous blood out of the body. This results in a backflow into the veins of the large systemic circulation. As a result, the pressure in the veins increases and fluid is forced into the surrounding tissue. This process is visible, for example, in leg and ankle edema. Blood also backs up in the organs. Enlargement of the spleen and liver can be the result. Furthermore, gastrointestinal problems can occur as a result of the backlog. One speaks then for example of a stasis gastritis. Possibly a congestion of the neck veins is visible. Because the right heart can pump less blood, less blood reaches the lungs and consequently less oxygen-rich blood reaches the left heart. This results in an undersupply of oxygen to the body. The skin of the affected person may turn blue (cyanosis). Patients also suffer from shortness of breath. They are no longer able to work hard physically and quickly become exhausted.
Diagnosis
If cor pulmonale is suspected, an ECG is first obtained. This usually reveals cardiac arrhythmias; in some cases, an absolute arrhythmia is visible. This is followed by x-ray and ultrasound examinations of the heart and measurement of oxygen saturation in the blood. As a reaction to the lack of oxygen, increased red blood cells are found in the blood. This is called polyglobulia. It may be possible to diagnose altered heart sounds and murmurs on auscultation of the heart. A catheter examination can be used to measure the pressure in the right heart. Since cor pulmonale is a symptom rather than a disease in its own right, diagnosis of the underlying disease is of great importance.Procedures such as pulmonary function testing, spiroergometry, and X-ray and ultrasound examinations of the lungs are used for this purpose.
Complications
Cor pulmonale (pulmonary heart disease) results from various diseases of the lungs, which can be associated with different complications. If left untreated, cor pulmonale progressively leads to deterioration. This can thus lead to death in a few years. The affected person has a strong decrease in the quality of life and suffers from a decrease in performance. In addition, there is a change in the lungs and the heart, so that lung failure or heart failure (cardiac insufficiency) are added. The patient also has to take oxygen frequently, which further impairs the quality of life. For example, cor pulmonale is caused by a pulmonary embolism. This is initially accompanied by shortness of breath and chest pain. In the course of time, inflammation of the pulmonary pleura (pleurisy) may occur. Pneumonia is also conceivable. In the worst case, these inflammations can spread over the entire body and thus trigger sepsis, which can turn into septic shock. Pneumothorax is also considered a cause of pulmonary heart failure. If the collapse of the lung persists for a long time, water can accumulate on the lung, leading to pulmonary edema. This can also lead to inflammation of the lungs. In asthma, another possible cause, the most feared complication that can develop is status asthmaticus. This is a medical emergency that cannot be easily treated with antiasthmatics.
When should you go to the doctor?
In the case of cor pulmonale, a doctor must be consulted in any case. This disease is life-threatening and must be treated in any case. As a rule, a doctor should be consulted when the affected person suffers from shortness of breath very suddenly. Pain in the area of the heart can also occur. In this case, however, an emergency doctor should be called or a hospital visited immediately. Visual complaints or dizziness can also indicate cor pulmonale. Furthermore, the patient may also have stomach or intestinal problems, which should also be examined. If the patient’s skin is already turning blue, immediate treatment is necessary in any case. The patient must avoid any physical stress. The treatment is usually performed in the hospital through a surgical procedure. Even after the operation, regular examinations by a cardiologist are necessary to avoid further heart problems. Permanent ventilation is also necessary in severe cases of cor pulmonale.
Treatment and therapy
Treatment of cor pulmonale involves therapy of the underlying disease. In pulmonary embolism, various drugs are administered to dissolve the thrombus. Surgical removal of the clot may be required. Chronic obstructive pulmonary disease is also treated primarily with medication. So-called bronchodilators widen the airways. Cortisone has an anti-inflammatory effect, and so-called mucopharmaceuticals loosen stuck mucus. This relieves the lungs and the right heart. The most important measure in the treatment of COPD and thus also of cor pulmonale is an absolute ban on smoking. In addition to treatment of the underlying disease, diuretics, nitrates or ACE inhibitors can be used to reduce the pressure in the pulmonary circulation. Permanent oxygen administration or even ventilation may be necessary.
Outlook and prognosis
The prognosis for cor pulmonale has been described by medical experts as very unfavorable. The chronic disease has a progressive course that cannot be stopped. Only the progression of cor pulmonale can be influenced. Without medical treatment, the risk of fatal progression increases within a few years of the onset of the disease. With medical care, the life span is prolonged and, in addition, the quality of life is significantly improved. In cor pulmonale, the patient feels low in energy, listless and tired. The organism is not able to mobilize new forces. This leads to a creeping process of physical degradation, which ends with demise. Organ changes occur that lead to irreparable damage. There are no possibilities to restore the tissue as well as the functioning of the organ. Prescribed medicines improve the well-being and can contribute to better breathing.In the most severe cases, the drugs remain ineffective. The patient’s survival can only be ensured by organ transplantation. A heart-lung transplant is necessary, which is associated with many risks. The patient can intervene supportively within the course of the disease. Avoiding nicotine consumption has a positive effect on breathing and can alleviate existing symptoms. However, this does not guarantee a cure.
Prevention
In chronic cor pulmonale, the best prevention is optimal treatment of chronic obstructive pulmonary disease. Any harmful substances, especially smoking, should be strictly avoided. Acute cor pulmonale is difficult to prevent. However, patients should be made aware of the dangers of leg vein thrombosis. Indeed, if thrombosis is treated early, pulmonary embolism with subsequent cor pulmonale can be prevented.
Follow-up
Options for follow-up care are usually very limited in cor pulmonale. Because the condition is treated by surgery in most cases, the affected person must recover afterward and allow the wound to heal completely. Likewise, unnecessary stress on the body must be refrained from, with the heart and lungs in particular not being stressed. Furthermore, in the case of cor pulmonale, patients are dependent on taking medication. Regular intake should be ensured, and interactions with other medications should also be discussed with the physician. In some cases, the affected person is also dependent on external ventilation with oxygen if lung function cannot be sufficiently restored. In the case of cor pulmonale, the affected person should not smoke under any circumstances. A healthy lifestyle with a healthy diet also has a very positive effect on the further course of the disease. Since the disease often leads to psychological complaints, it is also advisable to seek the support and therapy of a psychologist. Whether cor pulmonale results in a reduced life expectancy cannot be predicted in general.
Here’s what you can do yourself
When cor pulmonale occurs, the underlying condition must first be treated. If heart failure is already present, the doctor will also recommend a low-salt diet and dehydrating medications. Sometimes dietary supplements and digitalis are also prescribed. Smokers should stop consuming cigarettes immediately, as the symptoms are usually caused by severe lung disease. It is advisable to work out these measures together with the doctor in charge. Long-time smokers often need therapeutic support to quit, but can also make it easier to give up by using nicotine patches and the like. In any case, the trigger of the causative disease must be identified and remedied immediately. If the symptoms persist, treatment in hospital is required. Acute cor pulmonale is a medical emergency that must be treated immediately. First responders should immediately alert the emergency physician and place the affected person in the recovery position. Sometimes, life-sustaining measures must also be performed. Appropriate precautions must also be taken for prolonged hospitalization. In the long term, then, cor pulmonale always requires medical treatment. Everyday measures such as a healthy diet, exercise, and abstaining from stimulants can be used as a supplement.
