1. PRESENTED BY
MR OM VERMA
MSC LECTURER
RELIANCE INSTITUTE OF
NURSING
COR
PULMONALE
2. OBJECTIVES
• review the anatomy and
physiology of the respiratory
system
• review the anatomy and
physiology of the cardiovascular
system
• interpret the term cor pulmonale
• describe the etiology of cor
pulmonale
3. OBJECTIVES CONTINUED…...
• discuss the pathogenesis involved
in the disease process
• examine the clinical manifestations
closely
• differentiate the various diagnostic
measures
• explain the medical management
4. OBJECTIVES CONTINUED…...
• identify the surgical management
of cor pulmonale
• distinguish the nursing
management for cor pulmonale
including the nursing diagnosis
• obtain knowledge on the prognosis
of cor pulmonale
18. DEFINITION
It is the hypertrophy of the right
ventricle resulting from diseases
affecting the function and/or
structure of the lung, except when
these pulmonary alterations are the
result of diseases that primarily
affect the left side of the heart or
congenital heart disease(WHO,
1963)
19. DEFINITION
It is the enlargement of the right
ventricle secondary to diseases of
the lung , thorax, or pulmonary
circulation. Pulmonary
hypertension is usually a pre-
existing condition in the individual
with cor pulmonale. The most
common cause is COPD. (lewis)
20. DEFINITION
• abnormal enlargement of the right side of
the heart as a result of disease of the
lungs or the pulmonary blood vessels.
21. DEFINITION
It is a condition in which the right
ventricle of the heart enlarges (with or
without right sided heart failure) as a
result of diseases that affect the
structure or function of the lung or its
vasculature
22. DEFINITION
• Long-term high blood pressure in the
arteries of the lung and right ventricle of
the heart can lead to cor pulmonale. ...
Lung conditions that cause a low blood
oxygen level in the blood over a long time
can also lead to cor pulmonale
23. ETIOLOGY
• Conditions that restrict or
compromise ventilatory function,
leading to hypoxemia or acidosis e.g.
deformities of the thoracic cage,
massive obesity
• Conditions that reduce the pulmonary
vascular bed e.g. primary idiopathic
pulmonary arterial hypertension,
pulmonary embolus
24. Con…………………..
• acidosis is caused by an overproduction
of acid in the blood or an excessive loss of
bicarbonate from the blood
(metabolic acidosis), or by a buildup of
carbon dioxide in the blood that results
from poor lung function or depressed
breathing
25. ETIOLOGY
• Disorders involving nervous system,
respiratory muscles, chest wall ,
and pulmonary arterial tree may
also be responsible for cor
pulmonale
27. ETIOLOGY
• High blood pressure in the arteries of
the lungs is
called pulmonary hypertension. It is the
most common cause of cor pulmonale.
• COPD Lung conditions
• that cause a low blood oxygen level in the
blood over a long time can also lead to
cor pulmonale. ...
28. • AUTOIMMUNE DISEASES that damage
the lungs, such as scleroderma.
• scleroderma is a group of rare diseases
that involve the hardening and tightening
of the skin and connective tissues ...
29. ETIOLOGY
• sleep apnea, which causes stops in
breathing because of airway inflammation.
• Cystic fibrosis(CF) Scarring of the lung
tissue (interstitial lung disease)
39. • shortness of breath
• tiredness
• an increased heart rate
• lightheadedness
• chest pain
• leg or feet swelling
• fainting
• excessive coughing
• wheezing
• excessive fatigue
40. • Fainting is a sudden loss of
consciousness, usually temporary and
typically caused by a lack of oxygen in the
brain.
41. CLINICAL MANIFESTATIONS
If heart failure accompanies cor
pulmonale additional
manifestations such as
• Peripheral edema
• Weight gain
• Distended neck veins
• Full bounding pulse
• Enlarged liver
42. Retrosternal pain
• Pain behind the sternum (retrosternal
pain) is often associated with cardiac
conditions,
• SUBSTERNAL PAIN
• situated or perceived behind or below the
sternum substernal pain
47. • A brain natriuretic peptide
(BNP) test measures the amount of the
BNP hormone in your blood. BNP is made
by your heart to check the level of
hormone … normal level’’
• Age < 50 years, NT-proBNP >450 pg/mL -
HF likely
• Age 50-75 years, NT-proBNP >900 pg/mL
– HF likely
• Age >75 years, NT-proBNP >1800 – HF
likely
56. • CARDIAC GLYCOSIDES specifically
inhibit the active transport of Na ions out of
heart muscle cells.
• THEOPHYLLINE
• reversible (asthmatic) obstruction; smooth
muscle relaxation (i.e., bronchodilation)
and suppression of the response of the
airways to stimuli
59. LUNG TRANSPLANTS
• A catheter will keep your bladder empty.
Your surgeon will make a cut in your chest
to remove your diseasedlung. ... For
some lung transplants, you may be
connected to a heart-lung bypass
machine, which circulates your blood
during the procedure.
62. NURSING DIAGNOSIS
• Decreased cardiac output related
to restricted cardiac muscle
contractility as evidenced by
echocardiographic finding
• Impaired gas exchange related to
expiratory airflow obstruction as
evidenced by decreased oxygen
saturation levels
63. NURSING DIAGNOSIS
• Impaired tissue perfusion related to
decreased cardiac contractility and
expiratory airflow obstruction as
evidenced by increased capillary
refilling time >3 seconds
• Activity intolerance related to
decreased cardiac activity and
laboured respirations as evidenced
by difficulty in performing activities
of daily living
64. NURSING DIAGNOSIS
• Fatigue related to decreased
cardiac activity and laboured
respirations as evidenced by
difficulty in performing activities of
daily living
• Anxiety related to breathlessness
as evidenced by patient`s
verbalization and facial
expressions
65. NURSING DIAGNOSIS
• Imbalanced nutrition :less than
body requirement related to
breathlessness as evidenced by
weight loss
• Disturbed sleep pattern related to
shortness of breath as evidenced
by presence of dark circles around
the eyes
66. JOURNAL PRESENTATIONS
• A Case Report of Cor
Pulmonale in a Woman Without
Exposure to Tobacco Smoke:
An Example of the Risks of
Indoor Wood Burning
Alexander R. Opotowsky, MD,
MPH, Rajesh Vedanthan, MD,
MPH, and Joseph J. Mamlin, MD
68. ASSIGNMENT
1.The accessory muscles of
respiration includes
a)scalene muscles
b) sternocleidoid muscle
c) trapezius and pectoralis muscle
d) a, b and c
69. ASSIGNMENT
• The most significant change in
ECG readings for a patient with
cor pulmonale is in
a) Pwave
b) QRS complex
c) ST segment
d) T wave
70. ASSIGNMENT
• An example of cardiac glycoside
a)Digitalis
b) nifidipine
c) theophylline
d) Lasix
71. ASSIGNMENT
The area of heart mainly affected
in cor pulmonale is
a)Left side of heart
b) apex of the heart
c) right side of the heart
d) septum of the heart