Cor Pulmonale

WHAT YOU SHOULD KNOW:

• Cor pulmonale (KOR pull-muh-NALL-e) is when the right side of your heart begins to fail. It is also called right heart failure or pulmonary (PULL-mun-air-e) heart disease. Heart failure means that the pumping power of the heart is weaker than normal. Cor pulmonale is caused by high blood pressure in the lungs.
  
  
• The heart has 4 chambers or rooms. The 2 upper chambers are called the atria (A-tree-uh). The 2 lower chambers are called the ventricles (VEN-trih-kulls). Blood vessels bring blood from your body to the right atrium (A-tree-um) in your heart. The blood moves into the right ventricle where it is pumped into the lungs to get oxygen. The oxygen-rich blood goes into the left atrium and down into the left ventricle. The left ventricle pumps the blood into the aorta and then out to your body where the oxygen can be used.

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

RISKS:

The chance of having health problems that cause cor pulmonale increases if you smoke. You may have more problems with cor pulmonale if you live at a high altitude, or stay in bed for long periods of time. Even with treatment you could go into respiratory failure. This is when your lungs cannot work anymore. You may problems with your heartbeat that may cause your heart to stop. Caregivers will watch you closely for these problems. If you refuse care, cor pulmonale may get worse and you could die. Call your caregiver if you have questions about your condition, medicine, or care.

WHILE YOU ARE HERE:

• Activity: You may need to rest in bed. Until you are allowed out of bed, you can exercise your legs in bed. Do this by lifting one leg off the bed and drawing big circles with your toes. Then do the same thing with your other leg. Another good exercise is to lie on your side and pretend to pedal a bike. This makes your legs stronger and stops blood clots from forming. Stop if you become tired.
  
  
• Your caregiver will tell you when it's OK to get out of bed. Call your caregiver before getting up for the first time. If you ever feel weak or dizzy, sit or lie down right away. Then call your caregiver.
  
  
• Arterial line: An arterial line is a tube that is placed into an artery (blood vessel), usually in the wrist or groin. The groin is the area where your abdomen meets your upper leg. An arterial line may be used for measuring your blood pressure or for taking blood.
  
  
• Call button: You may use the call button when you need your caregiver. Pain, trouble breathing, or wanting to get out of bed are good reasons to call. The call button should always be close enough for you to reach it.
  
  
• Day/night confusion: If you stay in an intensive care unit (ICU), you may not know when it is daytime or nighttime. This is common for patients staying in ICU. Having the lights on all the time can cause it. The lights may cause you to feel or act confused. When you are moved to a room on a regular floor, you will become more aware of time.
  
  
• Deep breathing and coughing: Deep breathing helps to open the air passages in your lungs. Coughing helps to bring up sputum (mucus) from your lungs. You can deep breathe and cough on your own, or with the help of an incentive spirometer.
  
  
  • Take a deep breath and hold the breath as long as you can. Then push the air out of your lungs with a deep, strong cough. Put any sputum that you have coughed up into a tissue and throw it away. Take 10 deep breaths in a row every hour that you are awake, even during the night. Remember to follow each deep breath with a cough.
    
    
  • An incentive spirometer can help you take deeper breaths. Put the plastic piece into your mouth and take a steady, deep breath in. Hold your breath as long as you can, and then exhale (breathe out). Use your incentive spirometer 10 times every hour that you are awake, even during the night.
  
  
• Foley catheter: A Foley catheter is a tube that is put into your bladder to drain your urine into a bag. The bladder is an organ where urine is kept. Keep the bag of urine well below your waist. Lifting the urine bag higher will make the urine flow back into your bladder, which can cause an infection. Avoid pulling on the catheter because this may cause pain and bleeding, and the catheter may come out. Do not allow the catheter tubing to kink because this will block the flow of urine.
  
  
• Gown: A hospital gown is used so that caregivers can easily check and treat you. Caregivers will show you how to put on your gown. When you feel better you may be able to wear your own gown or pajamas.
  
  
• Heart monitor: This is also called an ECG, electrocardiogram, or telemetry. Sticky pads are placed on your chest or different parts of your body. Each pad has a wire leading to a small portable box (telemetry unit), or to a TV-type screen. This lets caregivers see a tracing of the electrical activity of your heart. The heart monitor may help caregivers see problems with the way your heart is beating. Do not remove any wires or sticky pads without asking your caregiver first.
  
  
• Informed consent: You have the right to understand your health condition in words that you know. You should be told what tests, treatments, or procedures may be done to treat your condition. Your doctor should also tell you about the risks and benefits of each treatment. You may be asked to sign a consent form that gives caregivers permission to do certain tests, treatments, or procedures. If you are unable to give your consent, someone who has permission can sign this form for you. A consent form is a legal piece of paper that tells exactly what will be done to you. Before giving your consent, make sure all your questions have been answered so that you understand what may happen.
  
  
• Intake/Output: With cor pulmonale, your body may keep too much fluid. This fluid stays in your feet and legs and may collect in your abdomen (belly). You may be given medicine to help get rid of this extra fluid. Because of this, caregivers may need to know how much you are urinating. Caregivers often call this "I&O".
  
  
  • When you are allowed, drink 6 to 8 glasses of water each day. Follow your caregiver's advice if you must limit the amount of liquid you drink. If you are on I&O, tell your caregiver how much liquid you drink.
    
    
  • Ask your caregiver if it is OK to flush your urine down the toilet. It may need to be measured before it is thrown away.
  
  
• IV: An IV is a tube placed in your vein for giving medicine or liquids. This tube is capped or connected to tubing and liquid.
  
  
• Oxygen: You may need extra oxygen to help you breathe easier. It may be given through a plastic mask over your mouth and nose. It may be given through a nasal cannula, or prongs, instead of a mask. A nasal cannula is a pair of short, thin tubes that rest just inside your nose. Tell your caregiver if your nose gets dry or if the mask or prongs bother you. Ask your caregiver before taking off your oxygen. Never smoke or let anyone else smoke in the same room while your oxygen is on. Doing so may cause a fire.
  
  
• Pneumatic boots: These are plastic boots or leggings put on your feet or legs over pressure stockings or ace wraps. The boots or leggings are connected to an air pump machine. The pump tightens and loosens different parts of the pneumatic boots. This helps push the blood back up to the heart to keep clots from forming.
  
  
• Postural Drainage: This treatment is also called "PD", chest physical therapy or chest PT. It helps loosen sputum (mucus from the lungs) in your lungs. A caregiver lightly claps on your back and chest with their hands. This breaks up the sputum in your lungs and makes it easier to cough up. Your caregiver may use a machine to lightly clap on your chest and back. PD can make it easier for you to breathe and may help you get better faster.
  
  
• Pulmonary (PULL-mun-air-e)Artery Line:
  
  
  • A pulmonary artery line or "PA cath" is one kind of central line catheter. It is a thin tube put in a vein near your collar bone or in your neck. The tube is then guided through your heart and into your lungs. One end of this catheter is hooked to a machine called a monitor. The monitor shows numbers that tell caregivers how your heart and lungs are doing. Another part of this catheter may be used to give medicine.
    
    
  • Tests called cardiac output may be done through the pulmonary artery catheter to see how well your heart is working. IV liquid is quickly pushed into your PA catheter. The monitor then measures how long it takes this liquid to move through your heart. This tells your caregivers how much blood your heart is pumping out each time it beats.
  
  
• Pulse oximeter: A pulse oximeter is a machine that tells how much oxygen is in your blood. A cord with a clip or sticky strip is placed on your ear, finger, or toe. The other end of the cord is hooked to a machine. Caregivers use this machine to see if you need more oxygen.
  
  
• Wrist restraints: These are cloth bands used to tie your wrists to the sides of your bed. These restraints are used to keep you from pulling out any special tubes you may have. Caregivers will check on you often to make sure you are safe and all your needs are met while you are restrained. Wrist restraints should only be used for a short time. They will be taken off when there is less chance that you will pull your tubes out.
  
  
• Support socks: You may need to wear support socks. The support socks are also called Ted Hose® or Jobst Stockings®. These socks may help decrease the swelling in your legs until you are walking more. They may also keep blood from staying in your legs and causing clots.
  
  
• Surgery: You may need surgery to to repair heart defects that are causing your cor pulmonale. It may be possible to treat cor pulmonale with a lung transplant or a heart-lung transplant.
  
  
• Ventilator: A ventilator is a special machine that can breathe for you if you cannot breathe well on your own. You may have an endotracheal tube (ET tube) in your mouth or nose. A tube called a trach may go into an incision (cut) in the front of your neck. The ET tube or trach is hooked to the ventilator. The ventilator can also give oxygen to you.
  
  
• Vital signs: This includes taking your temperature, blood pressure, pulse (counting your heartbeat), and respirations (counting your breaths). To take your blood pressure, a cuff is put on your arm and tightened. The cuff is attached to a machine which gives your blood pressure reading. Caregivers may listen to your heart and lungs by using a stethoscope. Your vital signs are taken so caregivers can see how you are doing.
  
  
• Weight: You may be weighed each day. Caregivers compare your weight from day to day. This helps caregivers see how much body fluid you have. When you lose too much body fluid you can become dehydrated. If you have too much body fluid, you may have trouble breathing and get swollen ankles. Your body does not work well when it has too much or too little fluid.

Tests: You may need one or more of the following tests to help caregivers plan your treatment.

• Blood gases: This test is also called an arterial blood gas or ABG test. Blood is taken from an artery (blood vessel) in your wrist, arm, or groin. The groin is the area where your abdomen meets your upper leg. Your blood is tested for the amount of "gases" in it, such as oxygen, acids, and carbon dioxide.
  
  
• Blood tests: You may need blood taken for tests. The blood can be taken from a blood vessel in your hand, arm, or the bend in your elbow. It is tested to see how your body is doing. It can give your caregivers more information about your health condition. You may need to have blood drawn more than once.
  
  
• Cardiac catheterization: This is a test to see how well your heart is working. Your arteries (blood vessels) may also be checked to see if they are blocked. A special tube is threaded into your heart through a blood vessel in your leg or arm. Dye may be given so x-ray pictures of your arteries show up better on a TV-like screen.
  
  
• Chest X-ray: This is a picture of your lungs and heart. Caregivers use it to see how your lungs and heart are doing. Caregivers may use the x-ray to see if the right side of your heart has gotten larger. Fluid collecting around your lungs and heart also shows up on a chest x-ray.
  
  
• Echocardiogram:
  
  
  • This test is also called an echo. It is a type of ultrasound, using sound waves to show pictures of the size and shape of your heart. An echo also looks at how your heart moves when it is beating. These pictures are seen on a TV-like screen.
    
    
  • This test is done while lying down on your back. Clear jelly will be squirted on your chest to help the ultrasound sensor slide easily. The sensor will be rubbed across your chest to see your heart from different angles. You may hear a whooshing noise, which is the sound of your blood flow. Caregivers may ask you to pedal a bike during the test (exercise echo) or you may get medicine before the test to increase blood flow to your heart muscle (stress echo). This test can tell how well your heart is pumping. An echo can also find problems, such as fluid around the heart or problems with your heart valves.
  
  
• 12-lead ECG: This test, also called an EKG, helps caregivers look for damage or problems in different areas of the heart. Caregivers may need to prepare your skin by shaving off some hair, or cleaning it with a gritty lotion. Sticky pads are placed on your chest, arms, and legs. Each sticky pad has a wire that is hooked to a machine or TV-type screen. A short period of electrical activity in your heart muscle is recorded. Caregivers will look closely for certain problems or changes in how your heart is working. This test takes about 5 to 10 minutes. It is important that you lie as still as possible during the test. You may need this test more than once.
  
  
• Pulmonary function tests: Pulmonary function tests, also called PFTs, help caregivers learn how well your lungs work. PFTs may also help your caregivers decide on the best treatment for you. During the tests, you breathe into a mouthpiece connected to a machine. The machine measures how much air you breathe in and out over a certain amount of time. This helps caregivers to see how well your lungs are moving and working.

Medicine: You may need one or more of the following medicines to treat the problems caused by cor pulmonale.

• Antibiotics(an-ti-bi-AH-tiks): This medicine may be given to prevent or fight infections caused by a germ called bacteria (bak-teer-e-uh).
  
  
• Blood pressure medicine: This medicine may be given to lower your blood pressure. Keeping your blood pressure under control protects your heart, lungs, brain, kidneys, and other organs.
  
  
• Blood thinners: This medicine keeps clots from forming in the blood that can cause strokes, heart attacks, and death. This medicine is especially important for people who have had repeated pulmonary emboli. Blood thinners may make it easier to bleed or bruise. If you shave, use an electric shaver. Use a soft toothbrush to brush your teeth to keep your gums from bleeding.
  
  
• Diuretics: This medicine is often called "water pills". Diuretics help your body get rid of extra fluid (edema) in your legs and ankles. This medicine may also help get rid of extra fluid in your lungs or around your heart. It may also decrease your blood pressure. You may urinate more often when taking diuretics.
  
  
• Expectorants: Expectorant medicine helps thin your sputum (mucus from the lungs). When sputum is thin, it may be easier for you to cough it up and spit it out. This may make your breathing easier, and may help you get better faster.
  
  
• Heart medicine: This medicine may be given to make your heart beat stronger or more regularly. There are many different kinds of heart medicines. Talk with your caregiver to find out what your medicine is and why you are taking it.
  
  
• Steroids: Steroid medicine may be given to decrease inflammation, which is redness, pain, and swelling.

Diet:

• Eat a variety of healthy foods every day. Your diet should include fruits, vegetables, breads, dairy products, and protein (such as chicken, fish, and beans). Eating healthy foods may help you feel better and have more energy.
  
  
• Ask your caregiver if you should be on a special diet. You may be told to eat foods that are low in fat or cholesterol. You may also be told to limit the amount of salt you eat. Special cookbooks can make it easier to plan low fat and low salt meals.
  
  
• Weighing too much can make your heart work harder and can cause serious health problems. Talk to your caregiver about a weight loss plan if you are overweight.

Copyright © 2008 Thomson Healthcare Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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