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PRESENTED BY
MR OM VERMA
MSC LECTURER
RELIANCE INSTITUTE OF
NURSING
COR
PULMONALE
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
OBJECTIVES CONTINUED…...
• discuss the pathogenesis involved
in the disease process
• examine the clinical manifestations
closely
• differentiate the various diagnostic
measures
• explain the medical management
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
REVIEW OF ANATOMY &
PHYSIOLOGY
UPPER RESPIRATORY
TRACT
LOWER RESPIRATORY
TRACT
LOWER RESPIRATORY
TRACT
RESPIRATORY PROCESS
CARDIOVASCULAR SYSTEM
HEART WALLS AND LAYERS
CHAMBERS OF THE HEART
VALVES OF THE HEART
CORONARY ARTERIES
HEART RATES
• NORMAL HEART RATE
• SINUS TACHYCARDIA
HEART RATES
• SINUS BRADYCARDIA
COR PULMONALE
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)
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)
DEFINITION
• abnormal enlargement of the right side of
the heart as a result of disease of the
lungs or the pulmonary blood vessels.
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
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
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
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
ETIOLOGY
• Disorders involving nervous system,
respiratory muscles, chest wall ,
and pulmonary arterial tree may
also be responsible for cor
pulmonale
Etiology
• blood clots in the lungs
• chronic obstructive pulmonary
disease
• lung tissue damages
• sleep apnea
• cystic fibrosis
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. ...
• 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 ...
ETIOLOGY
• sleep apnea, which causes stops in
breathing because of airway inflammation.
• Cystic fibrosis(CF) Scarring of the lung
tissue (interstitial lung disease)
PATHOGENESIS
GENETIC CAUSES UNKNOWN CAUSES
PATHOGENESIS
CONTINUED……
PULMONARY ENDOTHELIAL
INJURY
PATHOGENESIS
CONTINUED……
VASOCONSTRICTION
REMODELLING
PATHOGENESIS
CONTINUED……
SUSTAINED PULMONARY
HYPERTENSION
RIGHT VENTRICULAR
HYPERTROPHY
PATHOGENESIS
CONTINUED……
COR PULMONALE
Corpulmonale   om verma
Corpulmonale   om verma
Corpulmonale   om verma
CLINICAL MANIFESTATIONS
• Dyspnea
• Chronic productive
cough
• Wheezing respirations
• Retrosternal or
substernal pain
• Fatigue
• Polycythemia
• shortness of breath
• tiredness
• an increased heart rate
• lightheadedness
• chest pain
• leg or feet swelling
• fainting
• excessive coughing
• wheezing
• excessive fatigue
• Fainting is a sudden loss of
consciousness, usually temporary and
typically caused by a lack of oxygen in the
brain.
CLINICAL MANIFESTATIONS
If heart failure accompanies cor
pulmonale additional
manifestations such as
• Peripheral edema
• Weight gain
• Distended neck veins
• Full bounding pulse
• Enlarged liver
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
CLINICAL MANIFESTATIONS
• Palpitation
• Atypical chest pain
• Swelling of the lower extremities
• Dizziness and even syncope
DIAGNOSIS
• HISTORY COLLECTION
DIAGNOSIS
• PHYSICAL EXAMINATION
DIAGNOSIS
• LABORATORY TESTS
• ABG
ANALYSIS
• BRAIN
NATRIURETIC
PEPTIDE
• 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
DIAGNOSIS
• PULMONARY
FUNCTION
TEST
• CHEST
RADIOGRAPHY
DIAGNOSIS
• ELECTROCARDIOGRAPHY
• ECHOCARDIOGRAPHY
DIAGNOSIS
• PULMONARY
THROMBOEMBOLISM IMAGING
STUDIES
• ULTRAFAST, ECG-GATED CT
SCANNING
DIAGNOSIS
• MAGNETIC RESONANCE
IMAGING
• NUCLEAR IMAGING
DIAGNOSIS
• CARDIAC CATHETERIZATION
DIAGNOSIS
• LUNG BIOPSY
MEDICAL MANAGEMENT
• OXYGEN THERAPY
MEDICAL MANAGEMENT
• PHARMACOTHERAPY
• DIURETIC AGENTS
• VASODIALATORS
• BETA SELECTIVE AGONISTS
• CARDIAC GLYCOSIDES
• THEOPHYLLINE
• WARFARIN
• 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
SURGICAL MANAGEMENT
• PHLEBOTOMY
SURGICAL MANAGEMENT
• LUNG TRANSPLANTATION
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.
COMPLICATION
• Life-threatening shortness of breath
• Severe fluid buildup in your body
• Shock
• Death
NURSING MANAGEMENT
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
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
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
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
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
JOURNAL PRESENTATIONS
• Chronic Cor Pulmonale in Delhi :
A Study of 127 Cases
• S. PADMAVATI and S. N.
PATHAK
ASSIGNMENT
1.The accessory muscles of
respiration includes
a)scalene muscles
b) sternocleidoid muscle
c) trapezius and pectoralis muscle
d) a, b and c
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
ASSIGNMENT
• An example of cardiac glycoside
a)Digitalis
b) nifidipine
c) theophylline
d) Lasix
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
Corpulmonale   om verma

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