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Cor pulmonale

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Flashcards

Cor pulmonale

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Questions

USMLE® Step 1 style questions USMLE

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 76-year-old woman presents to the emergency department for evaluation of increased lower extremity swelling and shortness of breath. The patient has had progressive lower extremity swelling over the past several weeks to the point where she can no longer fit into her normal shoe size. In addition, she can no longer walk half a city block before becoming short of breath. Past medical history includes hypertension, diabetes, and a deep vein thrombosis after a long flight ten years ago. The patient has been smoking one pack of cigarettes per day for thirty-five years. Temperature is 36.1°C (97.0°F), pulse is 78/min, respirations are 16/min, blood pressure is 156/92 mmHg, and O2 is 90% on room air. Physical examination demonstrates a loud P2, jugular venous distension, faint bilateral end-expiratory wheezing, and 2+ pitting edema in the bilateral lower extremities. A chest X-ray is obtained and shown below. Which of the following best describes the pathophysiology of this patient’s lower extremity findings?  


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Cor pulmonale p. 316, 684, 734

from obstructive lung disease p. 692

penumonoconioses p. 696

pulmonary hypertension p. 697

right ventricular failure p. 684

Pulmonary hypertension p. 697

cor pulmonale p. 684

Sudden death

cor pulmonale p. 697

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Transcript

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Content Reviewers

Rishi Desai, MD, MPH

With cor pulmonale, cor is Latin for heart and pulmonale is Latin for lungs.

Cor pulmonale, then, is a relationship between the two, it’s when a disorder of the lungs causes dysfunction of the heart.

Normally, de-oxygenated venous blood from the body goes into the right atrium of the heart.

From there, it goes into the right ventricle and gets pumped into the lungs where it is reoxygenated as it goes through the pulmonary circulation.

The pulmonary circulation is a low-resistance system with pressures ranging between 10 mmHg and 14 mmHg.

After going through the lungs, oxygenated blood goes into the left atrium, and then into the left ventricle, and finally gets pumped back out to the body.

When the heart can’t pump enough blood to meet the body’s demands, it’s initially called heart dysfunction and can worsen to the point where it’s called heart failure.

This can happen in two ways, either it’s systolic heart failure, where the ventricles can’t pump blood hard enough during systole, or diastolic heart failure, where not enough blood fills the ventricles during diastole, called diastolic heart failure.

Heart failure can affect the right ventricle, the left ventricle, or both ventricles, so someone might have, right-sided heart failure, left-sided heart failure, or both which is called biventricular heart failure.

Cor pulmonale is when a lung disorder causes right-sided heart dysfunction that can develop into right-sided heart failure.

Lung disorders make it harder to oxygenate the blood, which can lead to hypoxia, or low oxygen levels.

In response, this triggers a process called hypoxic pulmonary vasoconstriction.

Let’s say you have a couple pulmonary arterioles here, meaning they’re in the lungs, and the alveoli of the lungs here, and oxygen exchange between the two.