Cor Pulmonale

WHAT YOU SHOULD KNOW:

• Cor pulmonale is a pulmonary (lung) heart disease. It is a condition that occurs when the right ventricle of your heart cannot pump properly. Your right ventricle is the part of your heart that pumps blood to your lungs. Your heart has four chambers (spaces) including two upper atria, and two lower ventricles. When you have cor pulmonale, your right ventricle must work harder to pump blood to your lungs. Working harder causes the walls in the right ventricle to thicken and widen. Cor pulmonale weakens your heart and leads to breathing problems. Fluid may begin to build up in your body and cause swelling in your ankles, legs, and abdomen (stomach).
  
  
• Cor pulmonale can be an acute (sudden onset) or chronic (long-term) condition. Cor pulmonale can be life-threatening if the right side of your heart fails. You may need a cardiac catheterization, MRI, echocardiography, or other tests to diagnose cor pulmonale. Treatment includes oxygen, medicines, or surgery. Treatment may help your heart pump better and improve your symptoms, such as breathing problems and weakness. Treatment may reverse your cor pulmonale or prevent it from getting worse. Treatment may save your life.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

• Medicines used to treat your cor pulmonale may cause headaches, dizziness, and low blood pressure. If you have a central line, you may get an infection. You may get a blood clot that travels to your lungs or brain. A blood clot in your lungs can cause chest pain and trouble breathing. A blood clot in your brain can cause a stroke. If you need a heart-lung transplant, your body may reject (not accept) the organs. If your body rejects your new heart and lungs, you may need another transplant. Even with treatment, your cor pulmonale may get worse, and you may die.
  
  
• Without treatment, your heart may weaken, and your symptoms may get worse. Fluid may build up in your lungs and body making it harder for you to breathe. You may get blood clots in your lungs and heart. Your heart, liver, and kidneys may fail. You may die without treatment. Talk with your caregiver if you have questions or concerns about your condition, treatment, or care.

WHILE YOU ARE HERE:

Informed consent:

A consent form is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.

Oxygen:

You may need extra oxygen if your blood oxygen level is lower than it should be. You may get oxygen through a mask placed over your nose and mouth or through small tubes placed in your nostrils. Ask your caregiver before you take off the mask or oxygen tubing.

IV:

An IV (intravenous) is a small tube placed in your vein that is used to give you medicine or liquids.

Central line:

This is a special IV catheter or tube. It is put into a large vein (blood vessel) near your collarbone, in your neck, or in your groin. The groin is the area where your abdomen meets your upper leg. Other central lines, such as a PICC, may be put into your arm. You may need a central line to receive medicines or IV fluids that need to be given through a big vein. You may need a central line if it is hard for caregivers to insert a regular IV. Also, a central line may stay in longer than a regular IV can. Some central lines may also be used to take blood samples.

Medicines:

You may need any of the following medicines:

• Heart medicine: This medicine is given to strengthen or regulate your heartbeat. It also may help your heart in other ways. Talk with your caregiver to find out what your heart medicine is and why you are taking it.
  
  
• Vasodilators: Vasodilators may improve blood flow by making the blood vessels in your heart and lungs wider. This may decrease the pressure in your blood vessels and improve your symptoms.
  
  
• Blood thinners: This medicine helps prevent clots from forming in the blood. Clots can cause strokes, heart attacks, and death. Blood thinners make it more likely for you to bleed or bruise. Use an electric razor and soft toothbrush to help prevent bleeding.
  
  
• Diuretics: This medicine is given to decrease edema (excess fluid) that collects in a part of your body, such as your legs. Diuretics can also remove excess fluid from around your heart or lungs and decrease your blood pressure. It is often called water pills. You may urinate more often when you take this medicine.

Monitoring:

• Vital signs: Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.
  
  
• Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity.
  
  
• Pulse oximeter: A pulse oximeter is a device that measures the amount of oxygen in your blood. A cord with a clip or sticky strip is placed on your finger, ear, or toe. The other end of the cord is hooked to a machine. Never turn the pulse oximeter or alarm off. An alarm will sound if your oxygen level is low or cannot be read.
  
  
• Pulmonary artery line: A pulmonary artery line, or PA cath, is a kind of central line catheter. It is a thin tube put in a vein near your collarbone, or in your neck or groin. The tube is then guided through your heart and into a blood vessel that goes to 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. The part of this catheter that is inside you may be used to give you medicine. You will need a chest x-ray after the PA line is placed, to be sure the line is where your caregiver wants it. You may have stitches on your skin where the line comes out. This holds the line in place.

Tests:

You may need the following tests:

• Blood tests: A sample of your blood may be taken to see how your body is working. The results of the blood tests may help your caregivers learn more about your cor pulmonale. The blood can be taken from a blood vessel in your hand, arm, or the bend in your elbow. You may need to have blood drawn more than once.
  
  
• 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. Your blood is tested for the amount of "gases" in it, such as oxygen, acids, and carbon dioxide.
  
  
• Cardiac catheterization: This is a test to see how well your heart is working. Your arteries 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: A chest x-ray is a picture of your heart and lungs. Caregivers use the x-ray to check the size of your heart. A chest x-ray may also show fluid around your heart and lungs.
  
  
• Echocardiogram: This test is a type of ultrasound. Sound waves are used to show the structure, movement, and blood vessels of your heart.
  
  
• 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.

Treatment options:

• IV fluids: If your blood pressure is low or you are dehydrated (decreased body fluid), you may need IV fluids. Fluids may help increase your blood pressure and help your heart pump better.
  
  
• Breathing assist: You may need the following treatments if you are not getting enough oxygen on your own:
  
  
  • Continuous positive airway pressure (CPAP): A CPAP machine is used to keep your airway open during sleep. With CPAP you wear a mask over your nose and mouth, or just your nose. The mask is held in place by soft elastic straps that go around your head. The mask is hooked up to the CPAP machine. The machine blows a gentle stream of air into the mask when you breathe. The stream of air helps to keep your airway open so you can breathe more regularly. Extra oxygen may be given to you through the machine also.
    
    
  • NPPV: Noninvasive positive-pressure ventilation, or NPPV, may help you breathe without using a breathing tube in your throat. Instead, a machine helps your lungs fill with air through a mask or a mouthpiece. If a mask is used, it may go over your nose and mouth, or just your nose. Extra oxygen may also be given to you through the machine.
    
    
  • Ventilator: A ventilator is a machine that can breathe for you if you cannot breathe well on your own. You may have an endotracheal (ET) tube in your mouth or nose. The ET tube is hooked to the ventilator.
  
  
• Surgery: Ask your caregiver for more information about the following surgeries:
  
  
  • Atrial septostomy: During an atrial septostomy, a catheter with a balloon on one end is moved into your atria. The balloon is inflated to make an opening between your right and left atria for blood to flow through. The blood is full of oxygen for your left ventricle to pump to your body.
    
    
  • Heart-lung transplant: During a heart-lung transplant, your failing heart and lungs are replaced with a donor heart and lungs. Organ donors are people who have chosen to give their organs and tissues to others when they die. You may need a heart-lung transplant if all other treatments have failed.

Copyright © 2011. Thomson Reuters. 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.

Learn more about Cor Pulmonale (Inpatient Care)