Right Sided Heart Failure (Cor Pulmonale)

Question 1

What is right sided heart failure

Answer 1

1. Alteration in structure and function of RV caused by a disorder of the pulmonary system

Question 2

What causes right sided HF

Answer 2

1. Pulm HTN can lead to cor pulmonale
   *dilation
   *hypertrophy
   *potential failure of the right ventricle

Question 3

How does RHF develop

Answer 3

1. Develops in response to acute or chronic changes in the pulmonary vasculature
   *pulm HTN

Question 4

Does prognosis get better or worse after the developing cor pulmonale

Answer 4

Worsens

Question 5

What is hypoxia pulmonary vasoconstriction (COPD causing RHF)

Answer 5

1. Redirects blood flow away from poorly ventilated areas in attempt to match ventilation and perfusion between, optimize oxygenation of blood

Question 6

What does hypoxia vasoconstriction lead to?

Answer 6

1. Chronic hypoxia
   *vascular remodeling
   *sustained vasoconstriction
2. Increased pulmonary vascular resistance
   *right heart doesn’t like high pressure
   *leads to hypertrophy / dilation and ultimately failure

Question 7

What is the patho for acute cor pulmonale

Answer 7

1. Occurs after a sudden and severe stimulus
2. RV dilatation and failure but no RV hypertrophy

Question 8

What is the patho for chronic cor pulmonale

Answer 8

1. Slowly evolving, slowly progressing pulmonary HTN
2. Leads to RV dilation and hypertrophy (COPD)

Question 9

What are the S/sx and will be found on the PE

Answer 9

1. Dyspnea MC symptom
2. Tussive or effort-related syncope
   *RV unable to deliver blood adequately to the left heart
3. Murmurs
4. Elevated JVP
5. Abdominal pain, ascities, heptomegaly
6. Lower extremity edema

Question 10

What is lower extremity edema due to?

Answer 10

1. Secondary to neurohormonal activation
2. elevated RV filling pressure, or
3. increased levels of carbon dioxide and hypoxia, which can lead to peripheral vasodilation

Question 11

What are the diagnostic studies for RHF

Answer 11

1. Chest X-rays
2. EKG
3. Echocardiogram
4. Spiral CT
5. MRI
   *for patients who are unable to be assessed with echo due to severe lung disease

Question 12

What will the echocardiography see?

Answer 12

Will measure the right ventricle thickness
*index of RV HTN
1. Estimate of RV systolic pressure
*value can vary
*get right heart catherterization to obtain pressure

Question 13

What is the treatment for CP from pulm HTN

Answer 13

Referral
1. Target underlying pulmonary disease
*decrease pulmonary vascular resistance to relieve pressure overload
2. Have adequate oxygenation
3. Decrease work of breathing using noninvasive mechanical ventilation, bronchodilation, and steroids

Question 14

What is the prognosis of cor pulmonale

Answer 14

1. Depends on the nature of the underlying cause and rate of progression
   *cor pulmonale (from COPD) 5 year survival rate 50%