Download Cor Pulmonale

天 津 医 科 大 学 授 课 教 案
（共 1 页、第 1 页）
课程名称：Internal Medicine
课程内容：Cor Pulmonale
教师姓名： Zhaohaiyan 职称：Associate chief physician
授课对象：
授课日期：14/5/2013
教材版本：internal medicine
Foreign Students
授课方式： Lecture
学时数： 2
听课人数：50
本单元或章节的教学目的与要求：
To master etiology，pathophysiolog，clinical feature, Laboratory, diagnosis and
treatment of Cor Pulmonale
授课主要内容及学时分配：
Introduction ， Etiology ， Pathophysiology ， Clinical feature, Laboratory, Diagnosis,
Treatment
重点、难点及对学生要求（包括掌握、熟悉、了解、自学）
Introduction ， Etiology ， Pathophysiology ， Clinical feature, Laboratory, Diagnosis,
Treatment
外语词汇：Cor Pulmonale，Pulmonary hypertension，COPD，Respiratory failure，
lung function
辅助教学情况：introduce case
复习思考题：
1 Etiology of Cor Pulmonale.
2 The ECG of Cor Pulmonale.
3 How to diagnose Cor Pulmonale?
参考资料：
CECIL TEXTBOOK OF MEDICINE
主任签字：
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天 津 医 科 大 学 授 课 教 案
（共 4 页、第 1 页）
Cor Pulmonale
INTRODUCTION
 Background:
 Definition: Cor pulmonale is defined as right ventricular enlargement, either
hypertrophy or dilatation or both, due to pulmonary artery hypertension, which
arises from structural or functional abnormalities of the lungs.
 Pulmonary hypertension is the common link between lung dysfunction and the heart
in cor pulmonale.
Etiology
 1.Diseases affecting air passages of the lung and alveoli
 Chronic obstructive pulmonary disease (COPD) is the most common cause of cor
pulmonale.
 Upper airways obstruction
 Asthma
 bronchiectasis
 Tuberculosis
 2.Diseases affecting thoratic cage movement
 Thoracotomy
 Neruomuscular diseases
 Idiopathic hypoventilation
 Pleural fibrosis
 3.Diseases affecting the pulmonary vasculature:
 Primary diseases of the arterial wall
 Embolic disorders: thromboembolism, tumor embolism, other embolism.
 4.Pressures on pulmonary arteries by mediastinal tumors, aneurysms.
Pathophysiology
 Several different pathophysiologic mechanisms can lead to pulmonary hypertension
and, subsequently, to cor pulmonale. These pathogenetic mechanisms include:
 (1)Pulmonary vasoconstriction:
due to alveolar hypoxia or blood acidemia;
 (2)Anatomic reduction of the vascular bed ：
compromise of the pulmonary secondary to lung disorders, eg, emphysema,
pulmonary thromboembolism, interstitial lung disease;

(3)Abnormalities of ventilatory mechanics:
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Alveolar pressure is commonly increased in COPD. Elevation in alveolar pressure
can result in compression of small pulmonary vascular branches, which, in turn,
increases pulmonary vascular resistance.

(4)Additional causes of pulmonary hypertension:
Increases in blood flow, pulmonary blood volume and blood viscosity.
CLINICAL
 History:
As with other aspects of cor pulmonale, the clinical, radiological, therapeutic and
prognostic features are influenced by the underlying disease process responsible for
the pulmonary hypertension.
 The patients with COPD and cor pulmonale may complain of cough, sputum
production and dyspnea.
 The primary pulmonary hypertension are likely to relate a history of dyspnea and
exertional syncope.
 Pulmonary thromboembolism take on dyspnea, chest pain and hemoptysis.
Laboratory
Respiratory failure
 Hypoxic respiratory failure（Ⅰtype）
 PaO2 < 60mmHg
 Hypercapnic-hypoxic respiratory failure （Ⅱtype）
 PaO2 < 60mmHg
 PaCO2> 50mmHg
Lung function
 COPD : FEV1/FVC<70%
Electrocardiography
 ECG abnormalities in cor pulmonale reflect the presence of RVH or underlying
pulmonary disease. These ECG changes may include :
 P-pulmonale pattern (an increase in P wave amplitude in leads 2, 3, and aVF)
 right axis deviation
 R/S amplitude ratio in V6

＜ 1
RV1+SV5＞1.05mV
Chest roentgenography
 In patients with chronic cor pulmonale, the chest radiograph may show
 right ventricular enlargement leads to an increase of the transverse diameter of
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the heart shadow to the right on the posteroanterior view.
 enlargement of the central pulmonary arteries with oligemic peripheral lung
fields.
 Pulmonary hypertension should be suspected when the right descending
pulmonary artery is larger than 15 mm in diameter.
Echocardiography
 right ventricular and right atrial enlargement
 pulmonic and tricuspid insufficiency
 right ventricular pressure overload
 pulmonary artery systolic pressure increase
Diagnosis
 Underlying disease
 severe bronchopulmonary disease
 thoracic cage disease
 pulmonary vasculature diseases
 Clinical feature
 Physical examination
 Chest radiograph
 right ventricular enlargement
 enlargement of the central pulmonary arteries
 the right descending pulmonary artery is larger than 15 mm in diameter
 Electrocardiography
 P-pulmonale pattern
 right axis deviation
 R/S amplitude ratio in V6 ＜ 1
 RV1+SV5＞1.05mV
 Echocardiogram
 right ventricular and right atrial enlargement
 pulmonic and tricuspid insufficiency
 right ventricular pressure overload
 pulmonary artery systolic pressure increase
 Pulmonary function
 Arterial blood gas analysis
 Right heart cardic catherization
TREATMENT
 Cardiopulmonary support for patients experiencing acute cor pulmonale with
resultant acute RV failure includes fluid loading and vasoconstrictor administration
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to maintain adequate blood pressure.
TREATMENT
 Oxygen therapy, diuretics, vasodilators, digitalis, theophylline, and anticoagulation
therapy are all different modalities used in the long-term management of chronic
cor pulmonale.
 Prognosis:
 The prognosis of cor pulmonale is variable depending upon underlying pathology.
 Patients with cor pulmonale due to COPD have a high 2-year mortality.
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