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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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| ==Overview==
| | {{SK}} Cor pulmonale; right ventricular failure; RV failure |
| '''Cor pulmonale''', also known as [[right heart failure]], is a medical term used to describe a change in structure and function of the [[right ventricle]] of the heart as a result of a [[Respiratory system|respiratory]] disorder. [[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 overview|Overview]]== |
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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 classification|Classification]]== |
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| Left untreated, [[cor pulmonale]] can lead to [[right heart failure]] and death.
| | ==[[Right heart failure pathophysiology|Pathophysiology]]== |
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| ==Pathophysiology== | | ==[[Right heart failure causes|Causes]]== |
| There are several mechanisms leading to pulmonary hypertension and cor pulmonale:
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| * 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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| ==Causes== | | ==[[Right heart failure differential diagnosis|Differentiating Right heart failure from other Diseases]]== |
| ===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 epidemiology and demographics|Epidemiology and Demographics]]== |
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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 risk factors|Risk Factors]]== |
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| * [[Adenopathy]]
| | ==[[Right heart failure natural history|Natural History, Complications and Prognosis]]== |
| * [[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==
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| 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]].
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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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| == External links ==
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| * [http://www.emedicine.com/med/topic449.htm Emedicine]
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| * The Merck Manual of Diagnosis and Therapy: [http://www.merck.com/mrkshared/mmanual/section16/chapter203/203c.jsp Cor Pulmonale]
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| * [http://www.pulmonaryheartdisease.com Pulmonary Heart Disease Symptoms]
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| | ==Case Studies== |
| | [[Right heart failure case study one|Case #1]] |
| {{Circulatory system pathology}} | | {{Circulatory system pathology}} |
| {{SIB}}
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| [[Category:DiseaseState]]
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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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| | [[Category:Disease]] |
| | [[Category:Cardiology]] |
| | [[Category:Pulmonology]] |