Cor pulmonale

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Cor pulmonale

ETP Cardiovascular System

ETP Cardiovascular System

Introduction to the cardiovascular system
Anatomy of the heart
Anatomy of the coronary circulation
Anatomy clinical correlates: Heart
Anatomy of the superior mediastinum
Anatomy of the inferior mediastinum
Anatomy clinical correlates: Mediastinum
Development of the cardiovascular system
Fetal circulation
Cardiac muscle histology
Artery and vein histology
Arteriole, venule and capillary histology
Cardiovascular system anatomy and physiology
Lymphatic system anatomy and physiology
Coronary circulation
Blood pressure, blood flow, and resistance
Pressures in the cardiovascular system
Laminar flow and Reynolds number
Resistance to blood flow
Compliance of blood vessels
Control of blood flow circulation
Microcirculation and Starling forces
Measuring cardiac output (Fick principle)
Stroke volume, ejection fraction, and cardiac output
Cardiac contractility
Frank-Starling relationship
Cardiac preload
Cardiac afterload
Law of Laplace
Cardiac and vascular function curves
Altering cardiac and vascular function curves
Cardiac cycle
Cardiac work
Pressure-volume loops
Changes in pressure-volume loops
Physiological changes during exercise
Cardiovascular changes during hemorrhage
Cardiovascular changes during postural change
Normal heart sounds
Abnormal heart sounds
Action potentials in myocytes
Action potentials in pacemaker cells
Excitability and refractory periods
Cardiac excitation-contraction coupling
Electrical conduction in the heart
Cardiac conduction velocity
ECG basics
ECG rate and rhythm
ECG intervals
ECG QRS transition
ECG axis
ECG normal sinus rhythm
ECG cardiac infarction and ischemia
ECG cardiac hypertrophy and enlargement
Baroreceptors
Chemoreceptors
Renin-angiotensin-aldosterone system
Arterial disease
Angina pectoris
Stable angina
Unstable angina
Myocardial infarction
Prinzmetal angina
Coronary steal syndrome
Peripheral artery disease
Subclavian steal syndrome
Aneurysms
Aortic dissection
Vasculitis
Behcet's disease
Kawasaki disease
Hypertension
Hypertensive emergency
Renal artery stenosis
Coarctation of the aorta
Cushing syndrome
Conn syndrome
Pheochromocytoma
Polycystic kidney disease
Hypotension
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Abetalipoproteinemia
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Lymphedema
Lymphangioma
Shock
Vascular tumors
Human herpesvirus 8 (Kaposi sarcoma)
Angiosarcomas
Truncus arteriosus
Transposition of the great vessels
Total anomalous pulmonary venous return
Tetralogy of Fallot
Hypoplastic left heart syndrome
Patent ductus arteriosus
Ventricular septal defect
Atrial septal defect
Atrial flutter
Atrial fibrillation
Premature atrial contraction
Atrioventricular nodal reentrant tachycardia (AVNRT)
Wolff-Parkinson-White syndrome
Ventricular tachycardia
Brugada syndrome
Premature ventricular contraction
Long QT syndrome and Torsade de pointes
Ventricular fibrillation
Atrioventricular block
Bundle branch block
Pulseless electrical activity
Tricuspid valve disease
Pulmonary valve disease
Mitral valve disease
Aortic valve disease
Dilated cardiomyopathy
Restrictive cardiomyopathy
Hypertrophic cardiomyopathy
Heart failure
Cor pulmonale
Endocarditis
Myocarditis
Rheumatic heart disease
Pericarditis and pericardial effusion
Cardiac tamponade
Dressler syndrome
Cardiac tumors
Acyanotic congenital heart defects: Pathology review
Cyanotic congenital heart defects: Pathology review
Atherosclerosis and arteriosclerosis: Pathology review
Coronary artery disease: Pathology review
Peripheral artery disease: Pathology review
Valvular heart disease: Pathology review
Cardiomyopathies: Pathology review
Heart failure: Pathology review
Supraventricular arrhythmias: Pathology review
Ventricular arrhythmias: Pathology review
Heart blocks: Pathology review
Aortic dissections and aneurysms: Pathology review
Pericardial disease: Pathology review
Endocarditis: Pathology review
Hypertension: Pathology review
Shock: Pathology review
Vasculitis: Pathology review
Cardiac and vascular tumors: Pathology review
Dyslipidemias: Pathology review
Sympatholytics: Alpha-2 agonists
Adrenergic antagonists: Presynaptic
Adrenergic antagonists: Alpha blockers
Adrenergic antagonists: Beta blockers
ACE inhibitors, ARBs and direct renin inhibitors
Thiazide and thiazide-like diuretics
Calcium channel blockers
cGMP mediated smooth muscle vasodilators
Class I antiarrhythmics: Sodium channel blockers
Class II antiarrhythmics: Beta blockers
Class III antiarrhythmics: Potassium channel blockers
Class IV antiarrhythmics: Calcium channel blockers and others
Lipid-lowering medications: Statins
Lipid-lowering medications: Fibrates
Miscellaneous lipid-lowering medications
Positive inotropic medications
Cardiomyopathies: Clinical
Congenital heart defects: Clinical
Valvular heart disease: Clinical
Infective endocarditis: Clinical
Pericardial disease: Clinical
Chest trauma: Clinical
Hypertension: Clinical
Pulmonary hypertension
Aortic aneurysms and dissections: Clinical
Raynaud phenomenon
Peripheral vascular disease: Clinical
Heart failure: Clinical
Coronary artery disease: Clinical
Deep vein thrombosis and pulmonary embolism: Pathology review
Fascia, vessels and nerves of the upper limb
Vessels and nerves of the forearm
Vessels and nerves of the hand
Anatomy of the abdominal viscera: Blood supply of the foregut, midgut and hindgut
Fascia, vessels, and nerves of the lower limb
Vessels and nerves of the gluteal region and posterior thigh
Anatomy of the popliteal fossa
Ventilation
Ventilation-perfusion ratios and V/Q mismatch
Gas exchange in the lungs, blood and tissues
Oxygen binding capacity and oxygen content
Oxygen-hemoglobin dissociation curve
Carbon dioxide transport in blood
Trypanosoma cruzi (Chagas disease)
Yellow fever virus
Rickettsia rickettsii (Rocky Mountain spotted fever) and other Rickettsia species
Arteriovenous malformation
Cerebral circulation

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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?  


Image reproduced from Wikimedia Commons 

External References

First Aid

2024

2023

2022

2021

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

Transcript

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Content Reviewers

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.

If one of these alveoli is poorly ventilated, the corresponding arteriole vasoconstricts to divert blood away from it.

This works pretty well, but when lots of alveoli are poorly ventilated like with a lung disorder, they all start to vasoconstrict and the mechanism backfires.

When lots of arterioles vasoconstrict together, there’s an increase in resistance and it leads to pulmonary hypertension - with the pulmonary blood pressure rising above 25 mm Hg.

The high pulmonary pressure makes it hard for the right ventricle to pump blood into the pulmonary circulation.

As compared to the left side, the right side of the heart is thinner walled and used to ejecting against a low pulmonary vascular resistance.

In acute lung disorders, like a pulmonary embolism, where a blood clot blocks blood flow in a pulmonary artery, the result is a rapid increase in right ventricular pressure that makes the right ventricle stretch out like a water balloon.