Cor Pulmonale

Cor Pulmonale

Right Sided Heart Disease, secondarily

caused by abnormalities of lung
parenchyme, airways, thorax, or
respiratory control mechanisms.
Noevidence of other heart conditions,
Acute vs. Chronic

Etiology of Cor Pulmonale ( I )

Lung and
Airways
COPD
Asthma
Bronchiectasis
DILD
Pulmonary
tuberculosis

Vascular
Occlusion
Multiple Emboli
Schistosomiasis
Filariasis
Sickle Cell
P. Pulmonary
Hypertension

Etiology of Cor Pulmonale ( II )

Thoracic Cage
Kyphosis > 100 o
Scoliosis > 120 o
Thoracoplasty
Pleural fibrosis

N-M Disease
Polio Myelitis
Myasthenia
Gravis
ALS
Muscular
Dystrophy

Etiology of Cor Pulmonale ( III )

Abnormal Respiratory Control

Idiopathic hypoventilation
Syndrome
Obesity hypoventilation syndrome
(Pick-Wickian syndrome)
Cerebrovascular disease

Hypercapnea
H

Hypoxia

Acidemia
A

Increased
Viscosity
Acidosis

Anatomic changes

Pulmonary Vessel
Restriction
Increased C.O.
C

Chronic Cor Pulmonale

Rt. Ventricular Failure

Pathologic Features

Lung : consistent with Specific diseases

Common Features: hypertrophy of
microvasculatures
Hallmark : Rt. Ventricular Hypertrophy
60g 200g, > 0.5 CM, RV/LV <2.5
Lt. Ventricular Hypertrophy
Hypertrophy of Carotid Body

Natural History

Several months to years to develop

All ages from child to old people
Repeated infections aggravate RV strain
into RV failure
Initilly respondes well to therapy but
progressively becomes refractory

Prevalence
Emphysema : less frequent
Cronic bronchitis : more common
US : 6-7 % of Heart failure
Delhi : 16%
Sheffield in UK : 30 40%
Autopsy in Chronic Bronchitis : 50%
More prevalent in pollution area or
smokers

Lab. Findings
X-Ray : Prominent pulmonary hilum
pulmonary
artery dilatation
Rt MPA > 20 mm
EKG : P- pulmonale, RAD, RVH
Echocardiography : RVH, TR, Pulm. Hypertension
ABG : Hypoxemia, Hypercapnea, Respiratory
acidosis
CBC : polycythemia
Cardiac catheterization

Treatment
Treat Underlying Disease : COPD Tx, Steroid,
Infection control, theophylline, medroxyprogesterone,
Continuous O2 : < 2-3L/min
Diuretics
Phlebotomy
Digoxin : controversial
Pul. Vasodilators
Beta adrenergic agents
Reduce Ventilation/Perfusion imbalance : Amitrine
bimesylate

Prognosis

1960-1970 : 3 yr mortality 50-60%

Recent times : 5 - 10 years or more

PENYAKIT JANTUNG
PARU
COR PULMONALE
CHRONIKA
PROF. DR. SAHARMAN LEMAN. DTMH & H. SpPD. KKV

- Patologis.
- Hipertrofi & Dilatasi Ventrikel Kanan
- O.K Hipertensi Pulmonal :
1. Penyakit Parenkim Paru
2. KLN. Vaskuler Paru
3. KLN. Toraks

Definisi
14

PPOM
Ventilasi
Hipoksemia
Asidosis

Luas Pembuluh Darah

Kerusakan DD Alveoli
Vasokontriksi

Polisitemia
Hipervolemia
Curahan Jantung

PATOFISIOLOGI
15

Hipertensi Pulmonal
Ventrikel Kanan >

Kegagalan Ventrikel
Kanan

1. GGN Jalan Udara Paru - Alveoli

a. Bronkitis Kronika
b. Asma Bronkhial Lama
c. Emfisema Paru
d. Fibrosis Paru, Skleroderma
e. Fibrosis Kistik
f. Reseksi Paru

ETIOLOGI
17

2. GGN Rongga Toraks - Otot Pernafasan

a. Kipo Skoliosis Berat
b. Sindroma Hipoventilasi:
- Obesitas Berat
- Tumor Intrakranial
- Poliomielitis
- Distrofi Muskulorum

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1. Gejala Klinis :
- G.J Kanan
- KLN. Paru
2. Pemeriksaan Fisis
-Peny, Paru
- Kesadaran
/ Koma
- JVP
- Hepatomegali, Asites, Edema
- Cor - Ventrikel Kanan >

DIAGNOSIS
19

3. X - Foto Toraks
- Paru
- Jantung
4. EKG
5. Analisa Gas Darah
- Pa O2 , Pa CO2
6. Fungsi Paru

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Tujuan
- Hipoksemia
- Retensi CO2
- Atasi Obstruksi
Cara
1. Umum
- Polusi Udara
- Fisioterapi
- Postural Drainage

PENATALAKSANAAN
21

2. Fungsi Paru
- Bronkodilator
- Mukolitik, Ekspektoransia
- Anti Biotik
3. Pemberian Oksigen
- O2 < 30%, Intermitent 1 - 3 l/mnt
4. Payah Jantung Kanan
- RG.
- Diuretika
- Digitalis
5. Flebotomi : HT > 80%

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