What is cor pulmonale?

Cor pulmonale is heart failure of the lower right pumping chamber (right ventricle). Right heart failure means the heart is not pumping blood to the lungs as well as it should. It may pump at a different speed, pump blood with less force, or pump less blood with each heartbeat.

What is the cause?

Pulmonary hypertension, which is high blood pressure in your lungs, causes the right ventricle to work harder. The right ventricle gets bigger over time and cannot work as well as it should. This high pressure can be caused by:

• Long-term lung diseases such as chronic obstructive pulmonary disease, or COPD or pulmonary fibrosis, which scars the lungs
• Sleep apnea, which is when you stop breathing for more than 10 seconds at a time many times during your sleep
• Long-term problem with blood clots in your lungs
• Acute respiratory distress syndrome, which is a sudden, severe lung problem that causes low levels of oxygen in your blood

All of these conditions can raise the pressure in the lungs and make it harder for blood to flow through. This means the heart works harder to pump blood through the lungs. The extra work causes the heart muscle of the right ventricle to get bigger. Over time, the muscle cannot get any bigger and cannot pump blood well.

What are the symptoms?

The first symptoms are usually shortness of breath, fast heart rate, or feeling lightheaded with activity. Over time, you may have symptoms with only mild activity or while resting, such as:

• Chest pain
• Cough
• Swelling of the legs and ankles
• Bluish or purplish areas the skin and fingernails

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you. Tests may include:

• Blood tests
• Chest X-ray
• CT scan, which uses X-rays and a computer to show detailed pictures of the chest
• An ECG (also called an EKG or electrocardiogram), which measures and records your heartbeat.
• An echocardiogram, which uses sound waves (ultrasound) to see how well your heart is pumping
• Heart catheterization, which uses a small tube called a catheter inserted into a blood vessel, dye, and X-rays to measure blood flow and see how well the heart is pumping
• Lung scan, which uses a small amount of radioactive material injected into your blood or inhaled to make detailed pictures of your lungs

How is it treated?

When cor pulmonale is caused by lung disease, treatment of the lung disease helps to ease the workload of the heart. The goal is to help your lungs work as well as possible.

You will probably need oxygen therapy to help you breathe better and keep your heart from working as hard. Treatment may also include medicine to:

• Expand blood vessels in the lungs and improve blood flow
• Prevent blood clots that might further block blood flow through the lungs
• Help your heart pump
• Decrease blood pressure in your lungs

A heart-lung transplant may be a possibility for some people.

How can I help take care of myself?

Follow the full course of treatment prescribed by your healthcare provider. In addition:

• Carefully follow your provider’s instructions for taking medicines.
• Do not smoke.
• Follow your provider’s recommendations for physical activity. Exercise helps strengthen your heart and body and improves your blood flow and energy level. Avoid outdoor exercise if it is very hot, cold or humid. Getting very hot or cold may cause your heart to work harder. Balance exercise with rest.
• Get enough rest, shorten your working hours if possible, and try to reduce the stress in your life. Anxiety and anger can increase your heart rate and blood pressure. If you need help with this, ask your healthcare provider.
• Women with cor pulmonale should avoid getting pregnant.
• Ask your provider if you should avoid drinking alcohol. Alcohol can weaken your heart or may worsen heart failure. It may also interfere with medicines you are taking.
• Try not to get sick with a cold or the flu, which can be very serious if you have pulmonary hypertension. Stay away from people who are sick and get a flu shot every year. Ask your healthcare provider if you need a pneumococcal shot.

Ask your healthcare provider:

• How and when you will hear your test results
• How long it will take to recover
• If there activities you should avoid and when you can return to your normal activities
• How to take care of yourself at home
• What symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup. Keep all appointments for provider visits or tests.