What is the pathophysiology of cor pulmonale?

Updated: Dec 15, 2017
  • Author: Derek Leong, MD; Chief Editor: Henry H Ooi, MD, MRCPI  more...
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Answer

Answer

The pathophysiology of cor pulmonale is a result of increased right-sided filling pressures from pulmonary hypertension that is associated with diseases of the lung. The increased afterload leads to structural alterations in the right ventricle (RV) including RV hypertrophy (RVH) which can be seen in chronic cor pulmonale.

Acute cor pulmonale: pulmonary embolism (more common) and acute respiratory distress syndrome (ARDS). The underlying pathophysiology in a massive pulmonary embolism causing cor pulmonale is the sudden increase in pulmonary resistance. In ARDS, RV overload can occur due to mechanical ventilation and the pathologic features of the syndrome itself. [2] Mechanical ventilation, especially higher tidal volumes, requires a higher transpulmonary pressure.

In the case of ARDS, cor pulmonale is associated with an increased possibility of right-to-left shunting through a patent foramen ovale, which carries a poorer prognosis. [3]


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