Pages

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. 

3 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.

    ReplyDelete
  2. After years of working in construction and smoking cigarettes,I was diagnosed with COPD and pulmonary fibrosis. As my illness progressed, I found myself  relying on supplemental oxygen around the clock. Even getting out of bed became a challenge.My doctors and specialists recommended a lung transplant, but after researching the pros and cons of such a drastic procedure, I decided to try something less invasive. I contacted multivitamin herbal cure cape town for organic natural treatment you can search for them on google. Following the COPD and pulmonary fibrosis herbal treatment procedure , my lung function has improved dramatically after my first four weeks of the herbal formula .My quality of life has gotten a lot better. I was amazed that I could breathe without any dead air. I no longer need oxygen and look forward to continued improvement because a specialist told me already I have a chance of getting rid of my condition totally due to the herbal treatment effectiveness . If you or someone you love has COPD, pulmonary fibrosis or another chronic lung disease, and would like to see improvements like mine they even guarantee me totally cure once the treatment is done , their website multivitamincare org they will put you through on the herbal process .

    ReplyDelete
  3. Herpes cure Testimony
    I was diagnosed with Genital Herpes for the past 2 years and I have been searching for a cure. I read a testimony on this platform of a lady who was cured from Diabetes with doctor Ahmed Usman Herbal medicine including the doctor's official email address. I contacted the doctor through his email, after much discussion and a few questions he prepared Herbal medicine and asked for my address. I received the Herbal medicine 3 days later and with his prescription I drank the Herbal medicine for 21 days. After concluding the herbal medicine I went for a test and my IgG result was confirmed Negative with no trace of the virus on my blood. Contact doctor Ahmed and be cured. email him on; drahmedusman5104 @ gmail . com or send him a whatsapp text +14436204203. He has Herbal cure for Diabetes, Hepatitis, Heart diseases. Hypertension, Strokes and Liver disease, Fibroid, Cancer, Asthma, Leukemia, Epilepsy, Menopause diseases.

    ReplyDelete