Tuesday, October 4, 2016

Cor pulmonale

Definition: Cor pulmonale is right heart failure caused by chronic pulmonary arterial hypertension.

Pathophysiology: Patients with pulmonary hypertension develop changes in the small blood vessels of the lungs that can lead to increased blood pressure in the right side of the heart. This makes it harder for the heart to pump blood to the lungs. If the pressure continues , the strain on the right side of the heart leads to cor pulmonale.

Chest radiograph showing enlarged pulmonary arteries from pulmonary artery hypertension.

Causes: include:
1. Lung diseases:

  • Asthma ( severe and chronic)
  • COPD
  • Bronchiectasis
  • Pulmonary fibrosis
  • Lung resection
2. Pulmonary vascular disease:
  • Pulmonary emboli
  • Pulmonary vasculitis
  • Primary pulmonary hypertension. 
  • Sickle cell disease
  • Acute respiratory distress syndrome.
  • Parasite infestation
3. Thoracic cage abnormality:
  • Kyphosis
  • Scoliosis
  • Thoracoplasty 
4. Neuromuscular disease:
  • Myasthenia gravis
  • Poliomyelitis
  • Motor neuron disease
5. Hypoventilation:
  • Sleep apnoea
  • Enlarged adenoids in children.
Clinical Features: 
Symptoms include:
  • Breathlessness
  • Fatigue
  • Syncope (fainting)
Signs include:
  • Cyanosis
  • Tachycardia
  • raised JVP with prominent a and v waves
  • loud P2 pansystolic murmur (tricuspid regurgitation)
  • early diastolic Graham Steell murmur. 
  • hepatomegaly
  • edema
Investigations: 
1. Complete blood count will show increased hematocrit and Hb (secondary polycythemia)
2. ABG will show hypoxia with or without hypercapnia
3. Chest X ray shows an enlarged right atrium and right ventricle, with prominent pulmonary arteries. 
4. ECG: p pulmonale, right axis deviation, right ventricular hypertrophy/strain.

Management
1. Treat the underlying cause.
2. In case of acute respiratory failure patients may need urgent care with ABG monitoring and giving oxygen accordingly. 
3. Patient with COPD may require long term oxygen therapy (15 hrs/day) .
4. Treat cardiac failure with diuretics such as furosemide 40-160 mg/24hrs PO. 
5. Monitor Urea and electrolytes and give amiloride or potassium supplements if needed,
Consider venesection if hematocrit is > 55%
6. Heart-lung transplantation is considered for younger patients. 

Prognosis: is poor with 50% of patients dying within 5 years. 

2 comments:

  1. Hello, my name is Betty. i was diagnosed of HIV virus 4 years back. Before then, i was dating this Derrick guy. we had something great going on. Our love life only lasted for 8 months. the sixth and seven month of our relationship, i began feeling very weak every now and then. But i never suspected anything until I kept on experiencing different symptoms like having sore throats, constant headache, body weakness e.t.c. I decided to go for a medical check up. I was tested HIV positive. when the doctor broke the news to me, it was as if my whole world had crumbled. it dawned on me then that Derrick has been lying to me. i was very mad to an extent i almost committed suicide. But there was nothing i could do, other than weep and weep. ever since then, i have been spending heavily on medications, going from one medical clinic or the other so I can look healthy. Though since i was a kid, i love herbs a lot. i take herbal tea with grandma while growing so i am quite familiar with herbs. early last year, i was on the internet and on a particular health blog, to check for herbal medication as alternative. I saw many comments and read many testimonies. Until i came across a particular testimony on how Dr.ugo cured a patient from herpes simplex virus using pure natural herbs. i reached out to the doctor because I also was thinking Herpes had no cure. I told him about my HIV status.He encouraged me not to panic that he will help me get my deliverance. he prepared some herbs and sent them to me. The herbs were in four 70ml bottles and I took them morning and night. i used as he directed, and in less than three weeks, i started having appetite to eat plenty of food and i gained back my strength. the fourth week,I consumed all the herbal meds. He encouraged me to go for a test which i did. This time, the result was negative. I quickly contacted the doctor and informed him of the news. I immediately asked him to prepare for Derrick too. He did and sent it. Today, me and Derrick are HIV free. All thanks goes to God Almighty for healing us through Dr.Ugo. if you are having any kind of sickness at all, Dr.Ugo is the right person to talk to and i assure you, you will be glad you did. His email: ugoherbalhome@gmail.com you can also write him on WhatsApp +2348104990619.

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    I told my Aunt,luckily it was the same Dr,we where referred to few months back by my pastor in church whom members have being testifying about of his cure We did contacted him and explained my problem to him.He prepared the medicine and sent to me with details of how to use and apply. After a while, I began to feel more strong than never before, I felt so lucky and happy when my Doctor congratulated me that he could found no HIV virus again in me. I knew I was free cos my body was so strong. His herbal medicine should have saved my parents life, i said!
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