Cor Pulmonale

What is cor pulmonale?

Cor pulmonale is enlargement of the heart's lower right pumping chamber (right ventricle) due to high blood pressure in the lungs.

How does it occur?

The most common causes of cor pulmonale are:

• chronic lung diseases such as emphysema (also called chronic obstructive pulmonary disease, or COPD)
• pulmonary fibrosis
• chronic bronchitis
• sleep apnea.

Less commonly, cor pulmonale may be caused by small blood clots, or emboli, that come from veins lower in the body and get stuck in blood vessels in the lungs. They may block blood flow.

All of these conditions can make it harder for blood to flow through the lungs. This means the heart has to keep working harder to pump blood to the lungs. The heart muscle of the right ventricle gets bigger, but after a while it cannot get any bigger and cannot keep up with the demand.

What are the symptoms?

The symptoms of cor pulmonale are similar to the symptoms of lung disease and other forms of heart failure. They include

• shortness of breath with activity
• cough
• swelling of the legs and ankles.

Cor pulmonale often causes cyanosis, which is a dark bluish or purplish discoloration of the skin and fingernail beds.

How is it diagnosed?

It is usually diagnosed with tests. For example:

• A chest X-ray often shows an enlarged heart together with the signs of lung disease.
• An electrocardiogram may show thickening of the muscle of the right ventricle.
• Cardiac ultrasound tests measure the thickness and the ability of the right ventricle to pump blood and help estimate the pressure in the blood vessels in the lungs.
• A blood sample from an artery may show a lower oxygen content than normal.
• Cardiac catheterization may be necessary. Catheterization can be used to measure pressures in the heart chambers, in particular the right-sided chambers that pump blood to the lungs. It can help show how well your heart is working. Sometimes these pressures are used to measure your heart's response to medicine.

How is it treated?

When cor pulmonale is caused by lung disease, treatment of the lung disease helps to ease the workload of the heart. The goal is to make the lungs work as well as possible.

Most people with cor pulmonale benefit from using oxygen 24 hours a day. A low level of oxygen in the blood causes spasm and narrowing of the blood vessels in the lung. Using oxygen expands the blood vessels so the heart does not have to work as hard. Oxygen can be supplied through a mask or plastic prongs that fit into the nose. Portable oxygen tanks are available.

Blood thinning medicine helps some people. Medicines that decrease the blood pressure in the lungs can also be helpful.

If you have cor pulmonale and get another illness (for example, pneumonia or bronchitis), you may need to stay at the hospital because the illness can make the cor pulmonale temporarily worse.

How long will the effects last?

In most cases the effects of cor pulmonale are life long.

How can I help take care of myself?

Learn to live within the limits of your condition. The following guidelines may help:

• Get enough rest, shorten your working hours if possible, and try to reduce the stress in your life. Anxiety and anger can increase your heart rate and blood pressure. If you need help with this, ask your healthcare provider.
• Check your pulse daily.
• Learn how to take your own blood pressure or have a family member learn how to take it. Check your blood pressure every day.
• Find a way to make sure that you take your medicines on time.
• Weigh yourself and write down your weight every day. Weigh yourself in the morning after you use the bathroom but before eating breakfast. Tell your healthcare provider as soon as possible if you gain 3 or more pounds in 1 day or 5 or more pounds in 1 week, or if you keep gaining weight over weeks to months. Weight gain may mean your body is having trouble getting rid of extra fluid.
• Follow your healthcare provider's advice on how much liquid you should drink.
• Consult a written diet plan and list of foods before you prepare snacks or meals.
• Follow your provider's recommendations for physical activity. Exercise helps strengthen your heart and body and improves your blood flow and energy level. Avoid outdoor exercise if it is very hot, cold or humid; consider indoor activities on these days. Balance exercise with rest.
• Quit smoking if you are a smoker.
• Ask your provider if you should avoid drinking alcohol. Alcohol can weaken your heart or may worsen heart failure. It may also interfere with medicines you are taking.
• Make sure that your activities do not make you too tired or short of breath.
• Get a flu shot every year. When you have heart failure, you should not get the nasal spray vaccine (FluMist).
• Get the pneumococcal pneumonia shot. If you are age 65 or older, you may need a second shot if you had your first shot before age 65 and it has been more than 5 years since the first shot. Ask your healthcare provider.
• Accept the fact that you will need to take medicines for your heart and lungs, and limit the salt in your diet for the rest of your life.
• Keep all medical appointments even when you are feeling well.

Noticing the early signs of worsening heart failure can save you a trip to the hospital. It is extremely important that you call your healthcare provider if you have symptoms of worsening heart failure.

Call your healthcare provider or 911 right away if:

• You have chest pain or pressure.
• You feel dizzy or faint or pass out.
• You are having trouble breathing.
• Your pulse is racing (very fast heart rate).

Call your provider as soon as possible if you have these less urgent symptoms of worsening heart failure:

• sudden weight gain of 3 pounds in one day or 5 pounds in a week
• new or increased shortness of breath
• more swelling in the feet, ankles, or legs, or abdominal bloating, or swollen hands or face
• more tiredness than usual
• frequent dry, hacking cough.

Also call your provider if you have a fever or new or increased sputum or your family and friends notice that you are not acting like yourself.

Early treatment for these symptoms helps them go away sooner.

How can I help prevent cor pulmonale?

Keep a healthy weight, exercise regularly, eat a healthy diet, and do not smoke.