Cor pulmonale is a pathological condition that is accompanied by hypertrophy followed by expansion of the right side of the heart. Such disorders develop against the background of increased pressure in the pulmonary circulation. The lack of therapy for such a disease leads to dangerous complications, up to myocardial infarction.
Of course, many people are looking for more information about pathology. Why does the disease develop? How does cor pulmonale develop? What symptoms should alert a sick person? Are there effective treatments? What prognosis can patients expect? The answers to these questions will be useful to many readers.
Brief description of the disease
Cor pulmonale is a very common disease, which is accompanied by expansion and enlargement of the right parts of the heart. The mechanism of pathology development is well studied.
As you know, the muscle layer of the right heart is not so strongly developed, as it is responsible only forpumping blood through the pulmonary circulation (in the vessels of the lungs, the blood is saturated with oxygen and returned back). Sometimes, for one reason or another, the pressure in the vessels rises, as a result of which the right ventricle and atrium are forced to cope with increased loads.
If it is a subacute or chronic form (when blood pressure increases gradually), then myocardial tissue slowly changes - the number of muscle fibers increases in order to cope with additional loads. Unfortunately, these parts of the heart are not designed for intensive work and the number of coronary vessels that feed the myocardium is less here. Such an organ disrupts tissue trophism. The heart muscles suffer from oxygen and nutrient deficiency.
Main causes of pathology
In fact, this condition is not an independent pathology - it develops against the background of a number of other diseases. It is extremely important to determine the causes of cor pulmonale at the time of diagnosis, since the success of treatment largely depends on this. The most common risk factors to consider are:
- Pulmonary embolism of the heart is a dangerous condition, which is accompanied by blockage of the lumen of the vessel by a blood clot. Such a pathology can be the result of injuries, fractures, diabetes mellitus, and an increase in blood viscosity. Acute cor pulmonale often develops against the background of thromboembolism.
- Pneumothorax is a violation of the integrity of the pleural cavity, which can beassociated with chest injuries, medical procedures, etc.
- Exudative pleurisy is an ailment characterized by inflammation of the outer shell of the lung with the release and subsequent accumulation of exudate in the pleural cavity.
- Acute cor pulmonale may be associated with a severe asthma attack.
- Tuberculosis is one of the causes.
- Pneumoconiosis is a fibrosis of the lung tissue, which is associated with prolonged inhalation of dust, metals, talc and other substances.
- Fibrosing alveolitis is an ailment that is accompanied by damage to the walls of the alveoli, followed by the replacement of functional tissues with connective ones. Of course, breathing and blood flow are disturbed.
- Congenital lung pathologies are also considered risk factors. Cor pulmonale sometimes develops against the background of polycystosis, cystic fibrosis, lung hypoplasia.
- Sarcoidosis is a disease in which large granulomas form in the lungs, which press on neighboring tissues, compress bronchioles and small pulmonary vessels.
- Chronic cor pulmonale often develops against the background of bronchitis (chronic).
- The list of causes includes bronchiectasis, which are pathologically altered bronchi.
- Emphysema is an ailment that is accompanied by an increase in lung volume against the background of bronchial expansion. Of course, the destruction of the walls of the small bronchi leads to disruption of gas exchange and blood circulation.
- The list of possible causes also includes vascular diseases, in particular, pathologies that affect the walls of the lungarteries, small pulmonary capillaries.
- Neuromuscular diseases, such as muscular dystrophies, polio, myasthenia gravis, myopathies, are accompanied by weakness of the respiratory muscles, which leads to impaired lung ventilation.
- Extremely rarely, cor pulmonale develops against the background of disorders of the respiratory center, which is located in the medulla oblongata. This is sometimes observed after a stroke and head injuries, against the background of meningitis, increased intracranial pressure, in case of poisoning with certain substances.
- The list of causes also includes chest deformities, in which ventilation of the lungs is significantly impaired.
Classification scheme
Of course, there are many schemes for classifying such a pathology. If you pay attention to the rate of development of the disease, then they distinguish:
- an acute form that develops quickly, sometimes in a few hours (may be associated with vascular thrombosis);
- subacute, in which the pathological process develops over several weeks or months;
- chronic cor pulmonale is a form of pathology that develops against the background of a gradual, prolonged increase in pressure in the vessels (the disease may be the result of chronic respiratory failure).
Stages of development of pathology
How does the disease progress? Cor pulmonale progresses in several stages.
- The preclinical stage proceeds without any symptoms, so the disease can only be diagnosed during an instrumental study. There is a transientpulmonary hypertension.
- Compensated stage - persistent hypertension is already taking place. This stage is characterized by already pronounced hypertrophy of the right ventricle.
- The stage of decompensation is accompanied by the appearance of symptoms of right ventricular failure.
Clinical picture: main symptoms
It is worth noting that the symptoms of cor pulmonale largely depend on the form and stage of development of the disease. The list of possible signs is quite impressive:
- Often, patients report a rapid heartbeat, which indicates tachycardia. The heart begins to contract faster in order to compensate for the lack of circulation. This is the most common sign of chronic cor pulmonale.
- Pathology is often accompanied by arrhythmias.
- Pain in the region of the heart also develop against the background of a similar pathology, in particular, its chronic form, because the heart is forced to work hard in conditions of oxygen starvation. Pain tends to get worse with physical activity.
- Acute cor pulmonale (as well as the chronic form of the disease) is accompanied by severe shortness of breath
- The list of symptoms also includes frequent dizziness, episodes of which often end in loss of consciousness.
- Cough is another symptom of cor pulmonale, however, it is associated with stagnation of blood in the pulmonary circulation. Cough may worsen during exercise.
- Many patients complain of increased fatigue,constant weakness, fatigue.
- If there is right-sided heart failure, then the list of symptoms can be supplemented with edema that appears against the backdrop of blood stasis. As a rule, excess fluid accumulates in the soft tissues of the lower extremities.
- Cyanosis of the skin is associated with overflow of vessels with venous blood and a decrease in the level of oxygen in arterial blood.
- When examining the patient, swelling of the neck veins can be found.
- Against the background of chronic cor pulmonale, the fingers of patients often change, acquiring the shape of "drumsticks". By the way, this is a common symptom, indicating various protracted diseases of the lungs and heart.
- Pain in the right hypochondrium is associated with an increase in the liver, which occurs against the background of increased pressure and stagnation of blood in the lower pudendal vein.
- At a later stage of chronic right-sided heart failure, ascites may develop, in which free fluid begins to accumulate in the abdominal cavity.
Chronic cor pulmonale
This form of the disease develops gradually, over many months, and sometimes even years. The causes of chronic cor pulmonale can be different:
- vascular disease, such as primary pulmonary hypertension or arteritis;
- surgery for partial or complete removal of a lung;
- obstructive airway diseases, in particular, bronchial asthma, chronic bronchitis, emphysema, as well as various formsfibrosis;
- obesity;
- adhesions in the pleura;
- chest and upper spine injuries.
In some patients, the disease occurs in a compensated form - there is an increase and expansion of the right ventricle, but the pathology is almost asymptomatic. On the other hand, the disease can always go into a decompensated form, in which symptoms of cardiopulmonary insufficiency occur.
Possible Complications
Treatment of cor pulmonale in most cases allows you to control the development of the disease. However, if the disease was diagnosed at a late stage or there were some comorbidities, then the likelihood of developing very dangerous complications is high:
- The most common complication of cor pulmonale is myocardial infarction. As already mentioned, the disease is accompanied by oxygen starvation, which leads to necrosis of muscle cells. In addition, the risk of developing myocardial infarction against the background of pulmonary hypertension increases with atherosclerosis, an increase in the level of cholesterol in the blood. Risk factors include smoking and avoiding prescription medications.
- Cor pulmonale is associated with significant blood flow disorders. Stagnation of blood in the portal vein leads to a number of dangerous complications, in particular, peptic ulcer of the stomach and small intestine. The fact is that due to stagnation of blood and oxygen starvation, the structure of the mucous membranes of the digestive tract changes, which makes them sensitive to the negative effects of external andinternal environment. The risk factors in this case include the penetration of Helicobacter bacteria into the body, irregular nutrition, alcohol abuse, etc. It is worth noting that ulcers that have developed against the background of heart failure are very difficult to treat.
- Cirrhosis of the liver is another possible complication that is associated with prolonged stagnation of blood inside the organ. In this case, the liver decreases, acquires a denser structure. The organ cannot filter and purify the blood, does not cope well with its functions, which leads to the accumulation of fluid in the abdominal cavity, as well as an increase in the size of the spleen.
- Often, patients with chronic forms of cor pulmonale face such an unpleasant consequence as hemorrhoids. The fact is that the veins located in the anus and rectum expand against the background of stagnation of blood. There is an expansion of the veins, swelling of the mucous membranes, the formation and enlargement of hemorrhoids. The disease is accompanied by discomfort and teeth in the anus, pain during bowel movements. Sometimes the vessels are damaged and traces of scarlet blood appear in the feces. Hemorrhoids can be surgically removed only after the patient's general condition has been brought under control, blood stasis has been eliminated, and other symptoms of cor pulmonale have been relieved.
- Varicose veins are another complication, which, again, is associated with congestion. Overflow of vessels with blood leads to a pathological expansion of their walls - this is how varicose veins develop. In most cases, the process isveins of the lower extremities. Patients complain of swelling, heaviness in the legs, spasms at night. In more severe cases, varicose veins are accompanied by inflammation of the vascular walls, the formation of blood clots.
During diagnosis, it is extremely important to check the patient for the above complications - additional treatment may be needed.
Diagnostic measures
Of course, if you notice some alarming symptoms in yourself, you need to see a doctor. Diagnosis of cor pulmonale is extremely important, because the effectiveness of therapy directly depends on the correct diagnosis.
- General examination of the patient and the collection of anamnesis in this case are extremely important. So the doctor can learn more about the symptoms that have appeared. The specialist also pays attention to the shape of the patient's fingers, the presence of edema and swollen veins, an increase in the abdomen and other external symptoms.
- As part of a general examination, auscultation and percussion of the heart are performed.
- Electrocardiography is extremely informative. During the procedure, the doctor can diagnose tachycardia, detect certain cardiac arrhythmias, and evaluate the work of the heart muscle.
- Echocardiography is a procedure that allows you to examine the heart using ultrasound equipment. During the examination, the doctor can examine the parts of the heart and valves, measure the thickness of the walls of the myocardium, and also check the speed of blood flow. Thus, the specialist can detect muscle hypertrophy and an increase in the volume of the chambers of the heart.
- X-raystudies give the doctor information about the size and location of the chest organs.
- A blood test is mandatory. With cor pulmonale, there is an increase in the number of erythrocytes, a decrease in their sedimentation rate, as well as an increase in the level of hemoglobin and leukocytes.
- If there are suspicions of infectious processes in the lungs, then bacteriological culture is additionally performed. For analysis, as a rule, sputum samples are taken. The procedure makes it possible to identify the pathogen, as well as assess its sensitivity to a particular drug.
- Respiratory function tests are being conducted to help identify chronic respiratory disorders.
How to treat an ailment?
Treatment of cor pulmonale must be comprehensive. The treatment regimen is drawn up by the doctor after studying the results of all studies.
Since the pathology is associated with oxygen starvation, the first thing to do is to restore its level. For this purpose, various drugs and techniques are used:
- First of all, patients are prescribed bronchodilators. Such funds help to expand the lumen of the bronchi, resulting in improved ventilation of the lungs - tissues receive more oxygen.
- Oxygen inhalations are effective. With the help of a special probe (in most cases it is inserted through the nasal passages), a gas mixture with a high oxygen content is delivered to the lungs. Of course, the procedure is carried out only in a hospital setting. When it comes to the treatment of chronic cor pulmonale, thenthe procedure is repeated for several weeks.
Stagnation of blood in the lungs and other organs increases the likelihood of developing infectious diseases. That is why antibiotics are sometimes included in the treatment regimen.
It is also important to control pulmonary hypertension and normalize blood pressure in the vessels. Various means are used for this purpose:
- Calcium channel blockers such as Diltiazem and Nifedipine help relax smooth muscles, which helps widen the lumen of the pulmonary capillaries.
- ACE inhibitors ("Captopril") prevent the development of vasospasm.
- Nitrates help to unload the heart, as they reduce the return of blood to the right atrium.
- Alpha-blockers (for example, Doxazosin) act on the receptors of the capillary walls, contributing to their expansion.
Congestion often leads to an increase in blood viscosity. This impairs fluid circulation and increases the chance of developing blood. In addition, thick blood does not pass through small capillaries and practically does not participate in gas exchange processes. That is why patients are prescribed blood thinners (for example, Reopoliglyukin).
Therapy, of course, is also aimed at relieving the symptoms of right ventricular heart failure.
- Treatment involves taking diuretics. They help to get rid of excess body water by removing fluid naturally. Such drugs help to cope with swelling,normalize blood pressure. The dose is selected individually.
- Cardiac glycosides are also used. They increase the contractile activity of the myocardium. Patients are prescribed small doses - too much of such drugs only increase the load on the heart and aggravate the situation.
Of course, it is necessary to treat the primary disease, because cor pulmonale is only a consequence of one or another pathological process. For example, adequate treatment of asthma and chronic bronchitis is necessary. With pneumosclerosis, the patient needs a lung transplant.
If necessary, symptomatic therapy is carried out. If thromboembolism or chest trauma caused the development of acute cor pulmonale, the patient needs resuscitation and surgical intervention.
In no case should you ignore the doctor's prescriptions, otherwise dangerous complications may develop.
Cor pulmonale: nutritional advice
As you know, the foods most often consumed by a person affect the work of his body, including blood pressure, the work of the excretory and circulatory systems. If the patient showed signs of cor pulmonale, then doctors recommend adjusting the diet, guided by simple rules:
- you need to reduce the amount of s alt (no more than 5 g per day);
- important to give up alcohol;
- from the diet should be excluded foods containing fats of animal origin (butter, lard, rich broths,pork);
- if swelling occurs, then temporarily reduce the amount of fluid consumed;
- recommended to reduce the caloric content of the daily diet;
- you need to include foods rich in vitamins in the menu.
This therapy should be followed for the prevention of various diseases of the cardiovascular system.
Prognosis for patients
How many live with cor pulmonale? What prognosis can the patient expect? Immediately it should be said that the outcome of the disease largely depends on the stage of development at which cor pulmonale was diagnosed and whether appropriate therapy was started on time. If the disease is found at the stage of compensation, then taking certain medications, the right lifestyle and an appropriate diet helps the patient lead a normal lifestyle (with limited physical activity, of course).
If there is a stage of decompensation, then the disease leads to disability - a person's working capacity is sharply reduced, his state of he alth worsens, he often loses the ability to serve himself even at the household level. Lack of therapy is fraught with dangerous complications up to the death of the patient.
