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| {{Infobox_Disease |
| | __NOTOC__ |
| Name = {{PAGENAME}} |
| | {{Right heart failure}} |
| Image = Cor pulmonale 1.jpg|
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| Caption = |
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| DiseasesDB = |
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| ICD10 = {{ICD10|I|26||i|26}}, {{ICD10|I|27||i|26}} |
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| ICD9 = {{ICD9|415.0}} |
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| ICDO = |
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| OMIM = |
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| MedlinePlus = |
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| eMedicineSubj = |
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| eMedicineTopic = |
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| MeshID = D011660 |
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| }}
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| {{SI}} | |
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| '''For the WikiPatient page for this topic, click [[Cor pulmonale (patient information)|here]]''' | | '''For the WikiPatient page for this topic, click [[Cor pulmonale (patient information)|here]]''' |
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| {{CMG}} | | {{CMG}}; {{AE}} [[User:Jad Z Al Danaf|Jad Z Al Danaf]], [[User:Rim Halaby|Rim Halaby]] |
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| '''''Synonyms and Keywords:''''' right ventricular failure, right heart failure, RV failure
| | {{SK}} Cor pulmonale; right ventricular failure; RV failure |
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| ==Overview== | | ==[[Right heart failure overview|Overview]]== |
| '''Cor pulmonale''', also known as [[right heart failure]], is a medical term used to describe a decline in right ventricular function, usually as result of either volume overload of the right ventricle or pressure overload of the right ventricle. When the term Cor pulmonale is applied, the right ventricular failure is due to an underlying [[Respiratory system|respiratory]] disorder.
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| ==Pathophysiology== | | ==[[Right heart failure classification|Classification]]== |
| [[Right ventricular hypertrophy]] or RVH is the predominant change in [[chronic (medicine)|chronic]] cor pulmonale although in [[Acute (medical)|acute]] cases dilation dominates. Both hypertrophy and dilation are the result of increased right ventricular pressure. | |
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| Dilation is essentially a stretching of the ventricle, the immediate result of increasing the pressure in an elastic container. Ventricular hypertrophy is an adaptive response to a long-term increase in pressure. Additional muscle grows to allow for the increased contractile force required to move the blood against greater resistance.
| | ==[[Right heart failure pathophysiology|Pathophysiology]]== |
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| To be classified as cor pulmonale, the cause must originate in the [[pulmonary circulation]] system. Two major causes are vascular changes as a result of tissue damage (e.g. disease, [[hypoxia (medical)|hypoxic injury]], chemical agents etc.), and chronic [[hypoxic pulmonary vasoconstriction]]. RVH due to a [[systemic]] defect is not classified as cor pulmonale.
| | ==[[Right heart failure causes|Causes]]== |
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| There are several pathophysiologic mechanisms leading to [[pulmonary arterial hypertension]] and cor pulmonale:
| | ==[[Right heart failure differential diagnosis|Differentiating Right heart failure from other Diseases]]== |
| * Pulmonary [[vasoconstriction]]
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| * Anatomic changes in vascularization
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| * Increased blood viscosity
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| * [[pulmonary hypertension|Idiopathic or primary pulmonary hypertension]]
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| * Increased volume overload of the right ventricle (e.g. [[Atrial septal defect]]
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| ==Causes== | | ==[[Right heart failure epidemiology and demographics|Epidemiology and Demographics]]== |
| ===Acute===
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| * [[Pulmonary embolism|Massive pulmonary embolization]]
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| * Exacerbation of chronic [[cor pulmonale]]
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| ===Chronic=== | |
| * [[Chronic obstructive pulmonary disease|COPD]]
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| * Loss of lung tissue following trauma or surgery
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| * [[Pierre Robin Sequence]]
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| * End stage [[Pneumoconiosis]]
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| ==Differential Diagnosis== | | ==[[Right heart failure risk factors|Risk Factors]]== |
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| In alphabetical order. <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>
| | ==[[Right heart failure natural history|Natural History, Complications and Prognosis]]== |
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| * [[Adenopathy]]
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| * [[Adult Respiratory Distress Syndrome]] ([[ARDS]])
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| * After pulmonary resection
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| * [[Alpha-1 Antitrypsin Deficiency]]
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| * Alveolar [[hypoxia]] in chronic high altitude exposure
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| * [[Amyotrophic Lateral Sclerosis]] ([[ALS]])
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| * Bilateral diaphragmatic paralysis
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| * [[Bronchiectasis]]
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| * Bronchopulmonary dysplasia following neonatal respiratory distress syndrome ([[RDS]])
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| * Chest wall dysfunction
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| * [[Chronic bronchitis]]
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| * Chronic fungal obstruction
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| * [[Chronic Obstructive Pulmonary Disease]] ([[COPD]])
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| * Collagen vascular disease
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| * [[Congenital heart disease]]
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| * [[Cystic Fibrosis]]
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| * Drug-induced lung disease
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| * [[Drugs]]
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| * [[Emphysema]]
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| * Fibrosing [[mediastinitis]]
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| * [[Guillain-Barre Syndrome]]
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| * [[Histiocytosis X]]
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| * [[HIV|HIV infection]]
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| * [[Hypersensitivity pneumonitis]]
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| * [[Idiopathic pulmonary fibrosis]]
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| * Impairment of the respiratory system
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| * [[Interstitial lung disease]]
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| * [[Kyphoscoliosis]]
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| * [[Left atrial myxoma]]
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| * [[Left ventricular failure]]
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| * [[Mitral valve disease]]
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| * [[Myasthenia Gravis]]
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| * Necrotizing and [[granulomatous arteritis]]
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| * Neuromuscular disease
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| * [[Obesity]]
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| * Persistent [[pulmonary hypertension]] of the newborn
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| * Pneumoconiose
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| * [[Poliomyelitis]]
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| * [[Portal hypertension]]
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| * [[Polyradiculitis]]
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| * [[Primary pulmonary hypertension]]
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| * Pulmonary capillary hemangiomatosis
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| * [[Pulmonary embolism]]
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| * [[Pulmonary emphysema]]
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| * [[Pulmonary fibrosis]]
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| * [[Sarcoidosis]]
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| * [[Schistosomiasis]]
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| * [[Sickle Cell Anemia]]
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| * [[Sleep Apnea]]
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| * [[Tuberculosis]]
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| * Tumor embolism
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| * Tumor masses
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| * Veno-occlusive lung disease
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| * [[Scleroderma]]
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| ==Complications== | |
| Blood backups up into the system venous system, including the [[hepatic vein]]. Chronic congestion in the [[Hepatic lobule| centrilobular]] region of the [[liver]] leads to [[hypoxia]] and fatty changes of more peripheral [[hepatocytes]], leading to what's known as [[nutmeg liver]]. Left untreated, [[cor pulmonale]] can lead to [[right heart failure]] and death.
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| | ==Diagnosis== |
| | [[Right heart failure history and symptoms| History and Symptoms]] | [[Right heart failure physical examination | Physical Examination]] | [[Right heart failure laboratory findings|Laboratory Findings]] | [[Right heart failure electrocardiogram|Electrocardiogram]] | [[Right heart failure chest x ray|Chest X Ray]] | [[Right heart failure CT|CT]] | [[Right heart failure MRI|MRI]] | [[Right heart failure echocardiography|Echocardiography]] |
| ==Treatment== | | ==Treatment== |
| Elimination of the cause is the most important intervention. In [[pulmonary embolism]], [[thrombolysis]] (enzymatic dissolution of the blood clot) is advocated if there is dysfunction of the [[right ventricle]]. In [[COPD]], long-term [[oxygen therapy]] may improve [[cor pulmonale]].
| | [[Right heart failure medical therapy|Medical Therapy]] | [[Right heart failure surgery|Surgery]] | [[Right heart failure primary prevention|Primary Prevention]] | [[Right heart failure secondary prevention|Secondary Prevention]] | [[Right heart failure cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Right heart failure future or investigational therapies|Future or Investigational Therapies]] |
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| [[Cor pulmonale]] may lead to [[congestive heart failure]] ([[CHF]]), with worsening of respiration due to [[pulmonary edema]], swelling of the legs due to [[peripheral edema]] and painful congestive [[hepatomegaly]]. This situation requires [[diuretic]]s (to decrease strain on the heart), sometimes [[nitrate]]s (to improve blood flow), phosphodiesterase inhibitors like [[Sildenafil]], [[tadalafil]] and occasionally [[inotrope]]s (to improve heart contractility). [[CHF]] is a negative [[prognosis|prognostic indicator]] in [[cor pulmonale]]. | |
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| ==References==
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| {{Reflist|2}}
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| | ==Case Studies== |
| | [[Right heart failure case study one|Case #1]] |
| {{Circulatory system pathology}} | | {{Circulatory system pathology}} |
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| [[Category:Disease]]
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| [[Category:Cardiology]]
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| [[Category:Pulmonology]]
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| [[Category:Signs and symptoms]]
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| [[Category:Physical Examination]]
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| [[de:Cor pulmonale]] | | [[de:Cor pulmonale]] |
| [[es:Cor pulmonale]] | | [[es:Cor pulmonale]] |
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| [[tr:Kor pulmonale]] | | [[tr:Kor pulmonale]] |
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| {{WikiDoc Help Menu}} | | {{WH}} |
| {{WikiDoc Sources}} | | {{WS}} |
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| | [[Category:Disease]] |
| | [[Category:Cardiology]] |
| | [[Category:Pulmonology]] |