An Overview of Cor Pulmonale

Cor pulmonale occurs when the blood pressure in the pulmonary artery—which carries blood from the heart to the lungs—increases and leads to the enlargement and subsequent failure of the right side of the heart. It can be a complication of several lung conditions including chronic obstructive pulmonary disease (COPD) and pulmonary embolism (PE).

Symptoms of cor pulmonale can include fatigue, swelling, and chest pain. Cor pulmonale is a progressive condition that can rapidly worsen. If left untreated, it may be life-threatening.

Causes

This type of right-sided heart disease can develop slowly or suddenly, and it is always caused by lung disease. COPD is the most common cause of cor pulmonale, but there are others as well. Often, cor pulmonale is more severe if you also have other types of heart disease, such as an arrhythmia or a history of a heart attack.

Common causes of cor pulmonale include:

• Cystic fibrosis
• Sleep apnea
• Scleroderma of the lungs
• PE (blood clot in the lungs)
• Lung tissue damage
• Acute respiratory distress syndrome (ARDS)
• Interstitial lung disease (ILD)
• Lung cancer

COPD is a common cause of heart failure, especially cor pulmonale. COPD is a group of pulmonary diseases that include emphysema and chronic bronchitis, which are progressive conditions that are associated with a number of complications.

Effect on the Heart

The heart has four chambers—left atria, left ventricle, right atria, and right ventricle. Cor pulmonale is right heart failure due to high pressure in the pulmonary arteries (arteries that lead from the heart to the lungs). As this condition develops, the right ventricle becomes dilated (widened) and thickened, and later the right atrium may be affected as well.

The right atrium receives deoxygenated blood from the left side of the heart and sends it to the right ventricle, which pumps blood to the lungs through the pulmonary artery. The left side of the heart is responsible for pumping blood to the entire body. Because of the extent of this job, the muscles of the left side of the heart have to be powerful as they pump with very high pressure. In contrast, the right side of the heart is not as powerful, as it can pump with much lower pressure to send blood to the nearby lungs.

Symptoms

The early symptoms of cor pulmonale can go unnoticed because the causative lung disease also causes symptoms, and some effects may be similar. To make matters even more confusing, symptoms of cor pulmonale often develop as the underlying lung condition worsens.

Common effects of cor pulmonale include:

• Wheezing and coughing
• Intolerance of exercise or even mildly strenuous physical activity (like walking upstairs)
• General fatigue
• Shortness of breath (dyspnea)
• Dizziness
• Edema (swelling of the feet and/or ankles)

Urgent Symptoms

Concerning symptoms that may signal a medical emergency include:

• Severe dyspnea at rest
• Enlarged neck veins
• Chest pain
• Syncope (loss of consciousness, fainting)
• Abdominal swelling
• Bluish tinge to your skin, nail bed, lips, or gums (cyanosis)

Pulmonary hypertension and cor pulmonale can lead to severe fluid retention which, in turn, can cause life-threatening dyspnea, shock, and even death.

Diagnosis

The diagnosis for cor pulmonale is usually made in the healthcare provider’s office. A physical exam typically picks up any abnormal heart sounds or rhythm, fluid retention, or protruding neck veins.

To provide a definitive diagnosis, your healthcare provider may also perform the following tests:

• Echocardiogram, which uses sound waves to visualize the heart
• Chest X-ray
• Computerized tomography (CT) scan of the chest
• Arterial blood gases (ABG) blood test
• Pulmonary artery catheterization, with the insertion of a catheter into the pulmonary artery to check for heart failure
• Ventilation/perfusion scan, which uses radioactive materials to examine the airflow and blood flow into the lung

Treatment

Treatment for cor pulmonale is focused on addressing the underlying illness. There are also a few treatments that can alleviate some effects of heart failure.

Management of the underlying lung condition can include:

• Bronchodilators
• Steriods
• Mucolytics
• Antibiotics if you have a lung infection
• Blood thinner or interventional procedure for the management of a PE

The use of calcium channel blockers is complicated when it comes to cor pulmonale. These drugs prevent calcium from entering the cells of blood vessel walls and may relax the pulmonary arteries, reducing pulmonary hypertension, but they may also adversely affect the heart and respiratory function in some instances.

Treatments aimed at alleviating the effects of cor pulmonale include:

• Oxygen therapy
• Anticoagulants (blood thinners), which may decrease mortality in persons with pulmonary hypertension
• Beta-blockers to improve heart function
• Diuretics, such as spironolactone, or renin-angiotensin system inhibitors to reduce edema
• Cholesterol-lowering agents to reduce the risk of blood clots

A heart transplant may be considered in very advanced cases, and a lung transplant may be considered for some types of lung disease.

A Word From Verywell

Cor pulmonale is a serious heart condition that develops as a complication of advanced lung disease. Because there is no treatment that can reverse cor pulmonale, prevention is key. Strategies for prevention include avoidance of smoking and airborne pollution as well as careful management of your lung disease.

If you have a lung condition, take extra precautions to avoid catching a contagious respiratory infection and pay close attention to any worsening signs and symptoms.