Skip to main content
SpringerLink
Log in

Cor Pulmonale

  • Chapter
  • First Online:
The Right Heart

  • 1306 Accesses

Abstract

Cor pulmonale refers to cardiac dysfunction consecutive to pulmonary disease. It reflects an uncoupling between the right ventricle and the pulmonary circulation. It is characterized by right ventricular (RV) overload in diastole and in systole, due to an increased right ventricular afterload. Two clinical entities are differentiated: acute cor pulmonale corresponds to an abrupt increase, leading to RV dysfunction or failure and may be observed in ARDS, anatomically massive pulmonary embolism, but also in mechanically ventilated patients in case of any situation with impaired RV contractility (sepsis, infarction,….); chronic cor pulmonale corresponds to a chronic and progressive increase in RV afterload, allowing the right ventricle to adapt up to a certain point (in this case, the right ventricle is hypertrophic). Echocardiography is the cornerstone of the diagnosis and the pivotal exam to distinguish acute and chronic cor pulmonale, even though the distinction is not always obvious and may be supported in part by the clinical scenario. We review the pathophysiology of the right ventricle and describe the diagnosis and treatment of cor pulmonale.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 189.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Abbreviations

ARDS:

Acute respiratory distress syndrome

CVP:

Central venous pressure

LV:

Left ventricle

MRI:

Magnetic resonance imaging

PAC:

Pulmonary artery catheter

PAOP:

Pulmonary artery occlusion pressure.

PAP:

Pulmonary artery pressure

References

  1. D’Alonzo GE, Barst RJ, Ayres SM, Bergofsky EH, Brundage BH, Detre KM, et al. Survival in patients with primary pulmonary hypertension. Results from a national prospective registry. Ann Intern Med. 1991;115:343–9.

    Article  PubMed  Google Scholar 

  2. Boissier F, Katsahian S, Razazi K, Thille AW, Roche-Campo F, Leon R, et al. Prevalence and prognosis of cor pulmonale during protective ventilation for acute respiratory distress syndrome. Intensive Care Med. 2013;39:1725–33.

    Article  PubMed  Google Scholar 

  3. Testa AG. Delle malattie del cuore. Milano: Schiepatti; 1831.

    Google Scholar 

  4. Harvey RM, Ferrer MI. A clinical consideration of cor pulmonale. Circulation. 1960;21:236–55.

    Article  CAS  PubMed  Google Scholar 

  5. McGinn S, White PD. Acute cor pulmonale resulting from pulmonary embolism. JAMA. 1935;104:1473–8.

    Article  Google Scholar 

  6. Piazza G, Goldhaber SZ. The acutely decompensated right ventricle: pathways for diagnosis and management. Chest. 2005;128:1836–52.

    Article  PubMed  Google Scholar 

  7. Redington AN, Rigby ML, Shinebourne EA, Oldershaw PJ. Changes in the pressure-volume relation of the right ventricle when its loading conditions are modified. Br Heart J. 1990;63:45–9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  8. Brimioulle S, Wauthy P, Ewalenko P, Rondelet B, Vermeulen F, Kerbaul F, et al. Single-beat estimation of right ventricular end-systolic pressure-volume relationship. Am J Physiol Heart Circ Physiol. 2003;284:1625–30.

    Google Scholar 

  9. Champion HC, Michelakis ED, Hassoun PM. Comprehensive invasive and noninvasive approach to the right ventricle-pulmonary circulation unit: state of the art and clinical and research implications. Circulation. 2009;120:992–1007.

    Article  PubMed  Google Scholar 

  10. Zapol WM, Kobayashi K, Snider MT, Greene R, Laver MB. Vascular obstruction causes pulmonary hypertension in severe acute respiratory failure. Chest. 1977;71:306–7.

    Article  CAS  PubMed  Google Scholar 

  11. Vieillard-Baron A, Schmitt JM, Augarde R, Fellahi JL, Prin S, Page B, et al. Acute cor pulmonale in acute respiratory distress syndrome submitted to protective ventilation: incidence, clinical implications, and prognosis. Crit Care Med. 2001;29:1551–5.

    Article  CAS  PubMed  Google Scholar 

  12. West JB, Dollery CT, Naimark A. Distribution of blood flow in isolated lung; relation to vascular and alveolar pressures. J Appl Physiol. 1964;19:713–24.

    CAS  PubMed  Google Scholar 

  13. Whittenberger JL, Mc GM, Berglund E, Borst HG. Influence of state of inflation of the lung on pulmonary vascular resistance. J Appl Physiol. 1960;15:878–82.

    CAS  PubMed  Google Scholar 

  14. Vieillard-Baron A, Loubieres Y, Schmitt JM, Page B, Dubourg O, Jardin F. Cyclic changes in right ventricular output impedance during mechanical ventilation. J Appl Physiol. 1999;87:1644–50.

    CAS  PubMed  Google Scholar 

  15. Monchi M, Bellenfant F, Cariou A, Joly LM, Thebert D, Laurent I, et al. Early predictive factors of survival in the acute respiratory distress syndrome. A multivariate analysis. Am J Respir Crit Care Med. 1998;158:1076–81.

    Article  CAS  PubMed  Google Scholar 

  16. Osman D, Monnet X, Castelain V, Anguel N, Warszawski J, Teboul JL, et al. Incidence and prognostic value of right ventricular failure in acute respiratory distress syndrome. Intensive Care Med. 2009;35:69–76.

    Article  PubMed  Google Scholar 

  17. Jardin F, Dubourg O, Bourdarias JP. Echocardiographic pattern of acute cor pulmonale. Chest. 1997;111:209–17.

    Article  CAS  PubMed  Google Scholar 

  18. Vieillard-Baron A, Prin S, Chergui K, Dubourg O, Jardin F. Echo-Doppler demonstration of acute cor pulmonale at the bedside in the medical intensive care unit. Am J Respir Crit Care Med. 2002;166:1310–9.

    Article  PubMed  Google Scholar 

  19. Quiroz R, Kucher N, Schoepf UJ, Kipfmueller F, Solomon SD, Costello P, et al. Right ventricular enlargement on chest computed tomography: prognostic role in acute pulmonary embolism. Circulation. 2004;109:2401–4.

    Article  PubMed  Google Scholar 

  20. Garcia-Alvarez A, Fernandez-Friera L, Garcia-Ruiz JM, Nuno-Ayala M, Pereda D, Fernandez-Jimenez R, et al. Noninvasive monitoring of serial changes in pulmonary vascular resistance and acute vasodilator testing using cardiac magnetic resonance. J Am Coll Cardiol. 2013;62:1621–31.

    Article  PubMed  Google Scholar 

  21. Kreitner KF, Wirth GM, Krummenauer F, Weber S, Pitton MB, Schneider J, et al. Non-invasive assessment of pulmonary hemodynamics in patients with chronic thromboembolic pulmonary hypertension (CTEPH) by high temporal resolution phase-contrast MR imaging: correlation with simultaneous invasive pressure recordings. Circ Cardiovasc Imaging. 2013;6:722–9.

    Article  PubMed  Google Scholar 

  22. Rabinovitch M, Fisher K, Gamble W, Reid L, Treves S. Thallium-201: quantitation of right ventricular hypertrophy in chronically hypoxic rats. Radiology. 1979;130(1):223–5.

    CAS  PubMed  Google Scholar 

  23. Vieillard-Baron A, Price LC, Matthay MA. Acute cor pulmonale in ARDS. Intensive Care Med. 2013;39:1836–8.

    Article  CAS  PubMed  Google Scholar 

  24. Guyton AC, Lindsey AW, Gilluly JJ. The limits of right ventricular compensation following acute increase in pulmonary circulatory resistance. Circ Res. 1954;2(4):326–32.

    Article  CAS  PubMed  Google Scholar 

  25. Vlahakes GJ, Turley K, Hoffman JI. The pathophysiology of failure in acute right ventricular hypertension: hemodynamic and biochemical correlations. Circulation. 1981;63:87–95.

    Article  CAS  PubMed  Google Scholar 

  26. Molloy WD, Lee KY, Girling L, Schick U, Prewitt RM. Treatment of shock in a canine model of pulmonary embolism. Am Rev Respir Dis. 1984;130:870–4.

    CAS  PubMed  Google Scholar 

  27. Rosenberg JC, Hussain R, Lenaghan R. Isoproterenol and norepinephrine therapy for pulmonary embolism shock. J Thorac Cardiovasc Surg. 1971;62:144–50.

    CAS  PubMed  Google Scholar 

  28. Schneider AJ, Teule GJ, Groeneveld AB, Nauta J, Heidendal GA, Thijs LG. Biventricular performance during volume loading in patients with early septic shock, with emphasis on the right ventricle: a combined hemodynamic and radionuclide study. Am Heart J. 1988;116:103–12.

    Article  CAS  PubMed  Google Scholar 

  29. Mahjoub Y, Pila C, Friggeri A, Zogheib E, Lobjoie E, Tinturier F, et al. Assessing fluid responsiveness in critically ill patients: false-positive pulse pressure variation is detected by Doppler echocardiographic evaluation of the right ventricle. Crit Care Med. 2009;37:2570–5.

    PubMed  Google Scholar 

  30. Mercat A, Diehl JL, Meyer G, Teboul JL, Sors H. Hemodynamic effects of fluid loading in acute massive pulmonary embolism. Crit Care Med. 1999;27:540–4.

    CAS  PubMed  Google Scholar 

  31. Piazza G, Goldhaber SZ. Acute pulmonary embolism: part II: treatment and prophylaxis. Circulation. 2006;114:42–7.

    Google Scholar 

  32. Ghignone M, Girling L, Prewitt RM. Volume expansion versus norepinephrine in treatment of a low cardiac output complicating an acute increase in right ventricular afterload in dogs. Anesthesiology. 1984;60:132–5.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, 9, avenue Charles-de-Gaulle, Boulogne Billancourt, 92100, France

    Xavier Repessé MD, Cyril Charron MD & Antoine Vieillard-Baron MD, PhD

Authors
  1. Xavier Repessé MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cyril Charron MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Antoine Vieillard-Baron MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Xavier Repessé MD .

Editor information

Editors and Affiliations

  1. National Pulmonary Hypertension Unit, Mater Misericordiae University Hospital, Dublin, Ireland

    Sean P. Gaine

  2. Department of Cardiology, Erasme University Hospital, Brussels, Belgium

    Robert Naeije

  3. Scottish Pulmonary Vascular Unit, Regional Heart and Lung Centre, Glasgow, United Kingdom

    Andrew John Peacock

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer-Verlag London

About this chapter

Cite this chapter

Repessé, X., Charron, C., Vieillard-Baron, A. (2014). Cor Pulmonale. In: Gaine, S., Naeije, R., Peacock, A. (eds) The Right Heart. Springer, London. https://doi.org/10.1007/978-1-4471-2398-9_12

Download citation

  • DOI: https://doi.org/10.1007/978-1-4471-2398-9_12

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-2397-2

  • Online ISBN: 978-1-4471-2398-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation