Lung heart

It is the affectation of the right ventricle of the heart, either in its function or in its morphology, secondary to pulmonary hypertension caused by diseases of the respiratory system.

Pulmonary hypertension involves an increase in pressure in the pulmonary arteries.

These leave the right ventricle of the heart and go each one to a lung to irrigate it in its entirety.

The increased pressure in these arteries puts an overload on the right ventricle, which leads to its enlargement.

Respiratory diseases capable of producing pulmonary hypertension can be of several types: affectation of the pulmonary parenchyma (that is, of the lung tissue) such as pulmonary fibrosis, collagenosis, etc…; airway involvement such as chronic bronchitis, emphysema, asthma, or sleep apnea syndrome; involvement of the rib cage such as kyphoscoliosis, thoracoplasties or other deformities of the cage, and affectations of the pulmonary veins and arteries such as pulmonary thromboembolism, primary pulmonary hypertension, vasculitis, etc …

Causes of cor pulmonale

The fundamental mechanisms by which this disease occurs are hypoxia and structural involvement of the pulmonary circulation vessels. Hypoxia is the reduction in the amount of oxygen in the blood.

It is the ultimate consequence of pulmonary diseases and is a very important stimulus for the production of vasoconstriction or narrowing of the pulmonary vessels. Vasoconstriction results in increased pulmonary pressure. The affectation in the structure of the vessels also occurs as a consequence of the sustained hypoxia since this causes changes, especially in the small pulmonary arteries, such as hypertrophy and stiffness of the wall. These changes are irreversible.

On other occasions, these changes in the wall of the pulmonary vessels are idiopathic (their cause is unknown).

Cor pulmonale symptoms

Up to 50% of patients may be asymptomatic.

The symptoms are due to insufficiency or failure of the right ventricle that cannot pump the blood that reaches it, which produces an accumulation of fluid in the body.

Its about:

• edema or swelling especially of the lower extremities.
• hepatomegaly or enlargement of the liver, which can sometimes be painful.
• intestinal edema with digestive disorders.
• pleural effusion and ascites (less common)
• symptoms of pulmonary hypertension: dyspnea on exertion and chest pain.

How is it diagnosed?

The diagnosis is based on the symptoms or symptoms of the disease and the underlying pathologies, physical examination, chest X-ray, electrocardiogram, echocardiogram, and invasive tests such as catheterization of the right heart.

Symptoms of the underlying disease are very important, such as cough and expectoration of chronic bronchitis, dyspnea of ​​emphysema, drowsiness in sleep apnea syndrome, etc …

The echocardiogram is the best procedure (also non-invasive), for the diagnosis, management and follow-up of these patients, it even allows it to be detected in the initial stages of the disease, when it has not yet produced symptoms.

Treatment of cor pulmonale

• Oxygen: it is the pulmonary vasodilator par excellence. It reverses the hypoxic phenomena responsible for the disease. It is the most useful treatment in the control of cor pulmonale when there is respiratory failure.
• Diuretics: in patients with cor pulmonale there is a volume expansion with venous congestion and peripheral edema. The use of diuretics produces a decrease in volume and therefore edema in the feet and digestive system.
• Digital: drug whose use is indicated only when it coexists with left heart failure and atrial fibrillation.
• Vasodilator drugs: their objective is to reverse the vasoconstriction that exists in the pulmonary arteries, however their use is controversial for different reasons (difficulty in analyzing the results obtained with the treatment and side effects on the general circulation). Hence the need for new studies to correctly establish its indication.

How can I avoid it?

The best treatment is the prevention of its development and progression. For this, a correct management of the underlying respiratory disease and respiratory failure must be carried out, avoiding hypoxia.

Before the appearance of the first symptoms, it is recommended to consult a doctor, since the treatment must begin before irreversible alterations appear.