Cor Pulmonale

GENERAL INFORMATION:

What is cor pulmonale? Cor pulmonale (KOR pull-muh-NALL-e) is when the right side of your heart begins to fail. Heart failure means that the pumping power of the heart is weaker than normal. Your heart has 4 chambers (rooms). The 2 upper chambers are called atria (A-tree-ah) and the 2 lower chambers are called ventricles (VENT-reh-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 to the left ventricle. The left ventricle pumps the blood out to your body where the oxygen can be used.

Causes: Many things can cause cor pulmonale or increase your risk of getting it. Cor pulmonale is caused by high blood pressure in the lungs. This high blood pressure may happen if you have lung problems, such as pulmonary embolism (M-bull-ih-zum). A pulmonary embolism is a blood clot blocking one of the blood vessels in the lung. Chronic obstructive pulmonary (PULL-mun-air-e) disease or "COPD" can also cause cor pulmonale. Other problems with the blood vessels in the lungs may also cause the right side of your heart to fail.

Signs and Symptoms: You may have one or more of the following signs or symptoms.

• Cyanosis (sigh-uh-NO-sis) which is blue fingernails, toenails, or lips.
  
  
• Neck veins that are distended (stick out).
  
  
• Dry, harsh cough.
  
  
• Caregivers will hear extra heart and lung sounds that are not normal when they listen to your chest.
  
  
• Fatigue (tiredness).
  
  
• Headache, confusion, extreme sleepiness, and coma.
  
  
• Shortness of breath, fast breathing, or breathing that worsens later in the day and at night.
  
  
• Swollen abdomen (belly) caused by extra fluid. This is called ascites (uh-SI-tees).
  
  
• Swelling of your legs, ankles, and feet. This is called edema (uh-DEEM-uh).
  
  
• Very large liver.
  
  
• Waking up breathless at night.

Tests: Many tests will be done to see what is causing your heart failure. You may have one or more of the following tests. These tests may be repeated as caregivers treat your disease over time. Ask your caregiver for the CareNotes™ handouts if you want more information about the following tests:

• 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 look for signs of infection like pneumonia, or to look for collapsed lungs. Chest x-rays may show tumors, broken ribs, or fluid around the heart and lungs.
  
  
• 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.
  
  
• Pulmonary angiogram: A pulmonary angiogram is done to check for problems with blood flow in your heart and lungs. A catheter (long, thin, bendable tube) is placed in a vein in your neck, under your collarbone, or in your groin. The groin is the area where your abdomen meets your upper leg. The catheter is then pushed into the pulmonary artery. Dye is put into the catheter. Chest x-rays are taken after the dye goes to your heart and lungs. The dye helps the blood vessels show up better on these x-ray pictures. Tell your caregiver if you are allergic to shellfish, as you may also be allergic to the dye used for this test.

Treatment Options: Treatment depends on what is causing your heart failure and your symptoms. The goal of treatment is to stop or prevent problems caused by cor pulmonale. Another goal is to keep the disease from getting worse. Without treatment you could die.

• Activity: Exercise and other activities cause you to need more oxygen so your heart has to work harder. You may have to decrease your activities and may not be allowed to do any hard exercises. You may even need to stay in bed for long periods of time.
  
  
• Diet: Eat healthy foods from all of the 5 food groups: fruits, vegetables, breads, dairy products, meat and fish. Eating healthy foods may help you feel better and have more energy. It may also help you heal faster. You may be told to eat foods that are low in fat and salt. Ask for the CareNotes™ handouts about low fat and low salt diets for more information.
  
  
• Medicine: You may need one or more of the following medicines to treat or prevent the cor pulmonale or problems caused by it.
  
  
  • Antibiotics (an-ti-bi-AH-tiks) to treat or prevent infections, such as infections of the heart valves. You also may have to take antibiotics before having dental care or other types of procedures.
    
    
  • Blood thinning medicine or aspirin to treat or prevent blood clots.
    
    
  • Diuretics (di-u-RET-iks) to get rid of extra fluid in the body and the lungs.
    
    
  • Heart medicine to help your heart beat stronger and more regular.
  
  
• 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.
  
  
• Surgery: You may need surgery 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.

Support:

• Cor pulmonale is a life-changing disease for you and your family. Accepting that you have heart disease is hard. You and those close to you may feel angry, sad, or frightened. These feelings are normal. Talk to your caregivers, family, or friends about your feelings. Let them help you. Encourage those close to you to talk to your caregivers about how things are at home. Your caregiver can help your family better understand how to support a person with heart disease.
  
  
• You may also want to join a support group. This is a group of people who also have heart disease. Ask your caregiver for the names and numbers of support groups in your town. You can contact the following national organizations for more information.

• American Heart Association National Center
  7272 Greenville Avenue
  Dallas, TX 75231-4596
  Phone: 1-800-242-8721
  Web Address: http://www.americanheart.org
  

• National Asthma Education and Prevention Program
  National Heart, Lung and Blood Institute
  National Asthma Education and Prevention Program
  P.O. Box 30105
  Bethesda, MD 20824-0105
  Phone: 1-301-592-8573
  Web Address: http://www.nhlbi.nih.gov/about/naepp/
  

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.

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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