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Cor Pulmonale

What is cor pulmonale?

Cor pulmonale is a condition that occurs when the right side of your heart cannot pump properly.


What causes cor pulmonale?

Cor pulmonale is caused by pulmonary hypertension (PH). PH is high blood pressure in the arteries of your lungs. Normally, the pressure in these arteries is low to allow blood flow. PH causes the right side of your heart to work harder to get blood to your lungs. Eventually, blood cannot flow through your lungs and backs up in the right side of your heart. This makes it difficult for that side to pump properly.

What increases my risk for cor pulmonale?

  • Acute lung diseases, such as acute respiratory distress syndrome or a blood clot in your lungs

  • Chronic lung or heart disease, such as COPD or cardiomyopathy

  • Conditions that decrease how much your chest expands, such as obesity or scoliosis

  • Living at high altitude

  • Mechanical ventilation (being on a ventilator)

  • Sleep-related breathing disorders, such as obstructive sleep apnea

What are the signs and symptoms of cor pulmonale?

  • Shortness of breath

  • Weakness and feeling more tired than usual

  • Chest pain

  • Headaches

  • Fainting or feeling lightheaded

  • Loss of appetite

  • Swelling in your abdomen, legs, and feet

How is cor pulmonale diagnosed?

Your caregiver will ask about your symptoms and any health problems you have. He will listen to your heart and lungs. He will check for swelling in your abdomen, ankles, and feet. You may need any of the following tests:

  • Blood tests: A sample of your blood is tested to check your heart and lung function. Your blood is also tested for the amount of gases in it, such as oxygen, acids, and carbon dioxide.

  • EKG: This tests checks your heart rhythm for problems, such as heart damage or disease.

  • 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 can also show fluid around your heart and lungs.

  • Echocardiogram: An echocardiogram (echo) uses sound waves to show pictures of the size and shape of your heart. An echo records how your heart moves when it is beating and how blood flows through your heart. These pictures are seen on a monitor.

  • CT scan: This test is also called a CAT scan. An x-ray uses a computer to take pictures of your heart and lungs. The pictures can show conditions that may have caused cor pulmonale. You may be given dye before the pictures are taken to help caregivers see the pictures better. Tell caregivers if you are allergic to iodine or shellfish. You may also be allergic to the dye.

  • MRI: This scan uses powerful magnets and a computer to take pictures of your heart and lungs. An MRI may show the size and function of the right side of your heart. You may be given dye to help the pictures show up better. Tell the caregiver if you have ever had an allergic reaction to contrast dye. Do not enter the MRI room with anything metal. Metal can cause serious injury. Tell caregivers if you have any metal in or on your body.

  • VQ scan: This is a ventilation (V) and perfusion (Q) test. It shows the airways and blood vessels in your lungs. It will tell your caregiver how well your lungs are working. Radioactive dye is put into your vein to show how blood flows in your lungs. You will then breathe in a special gas. Pictures are taken to see how well your lungs breathe in oxygen.

How is cor pulmonale treated?

  • Medicines:

    • Diuretics: These are 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 will urinate more often when you take this medicine.

    • 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 your 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: These help prevent clots from forming in the blood. Blood thinners make it more likely for you to bleed or bruise. Use an electric razor and soft toothbrush to help prevent bleeding.

  • Surgery:

    • 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 and lung transplant: You may need to have a heart and lung transplant if other treatments have not worked.

What are the risks of cor pulmonale?

  • If you have a central line, you may get an infection. You may get a blood clot in your limb. The blood clot can break loose and travel to your lungs. A blood clot in your lungs can cause chest pain and trouble breathing. If you need a heart-lung transplant, your body may reject 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. This can be life-threatening.

  • 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. This is life-threatening.

How can I manage my breathing?

  • Breathing support: You may need oxygen along with other devices, such as continuous positive airway pressure (CPAP), to help you breathe easier.

  • Pulmonary rehabilitation: This may help improve your symptoms and prevent your cor pulmonale from getting worse. You may learn breathing exercises to increase the oxygen levels in your body and improve the function of your heart.

  • Do pursed-lip breathing: Use this breathing technique when you feel short of breath. It may be especially helpful before you start an activity.

    • Inhale (breathe in) through your nose. Be sure you are using the muscles in your abdomen to help fill your lungs with air.

    • Slowly exhale (breathe out) through your mouth with your lips pursed (slightly puckered). You should make a quiet hissing sound as you breathe out through your pursed lips.

    • It should take you twice as long to breathe out as it did to breathe in. Count to 4 slowly as you breathe out.

    • Repeat this exercise several times.
      Breathe in Breathe out

How can I manage my cor pulmonale?

  • Limit your liquids as directed: Ask your caregiver how much liquid you should drink each day. Too much liquid can increase your risk for swelling and make your cor pulmonale worse.

  • Eat healthy foods: You may need to change what you eat to control your symptoms. Foods that are low in salt are best. Healthy foods include fruit, vegetables, whole-grain breads, low-fat dairy products, beans, lean meat, and fish.

  • Exercise: Talk to your caregiver about the best exercise plan for you. Exercise may help you lose weight, which will decrease stress on your heart.

  • Prevent pregnancy: During pregnancy, your heart needs to work harder than usual. Pregnancy may be life-threatening to both you and your baby. Talk with your caregiver about safe ways to prevent pregnancy.

  • Do not drink alcohol: Alcohol can make it harder for you to breathe, and can worsen your cor pulmonale. Talk with your caregiver if you drink alcohol and need help to stop.

  • Do not smoke: If you smoke, it is never too late to quit. Tobacco smoke can make your heart and lung symptoms worse. It can also cause heart and lung disease. Ask your caregiver for information if you need help to stop smoking.

When should I contact my caregiver?

Contact your caregiver if:

  • You are more tired than usual.

  • You are urinating much less than usual.

  • You feel dizzy, lightheaded, or confused.

  • You have new or increased swelling in your abdomen, legs, or feet.

  • You are more short of breath or wake from sleep gasping for air.

  • You have questions or concerns about your condition or care.

When should I seek immediate care?

Seek care immediately or call 911 if:

  • You cough up blood.

  • You have chest pain that does not go away with rest.

  • You have severe shortness of breath.

  • Your hands or feet suddenly feel cold to the touch.

  • Your heart is beating faster than normal for you.

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. 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.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

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