Cor Pulmonale: When a DISORDER OF THE LUNGS causes a DYSFUNCTION OF THE HEART🫁🔀🫀
Often times when we think about “CHF” or “Heart Failure,” our minds often jump to a cardiac issue or “swollen legs and crackling lungs.” While none of that is a wrong way to think, it could be an underlying pulmonary issue!🌬
Now depending on the capabilities of your EMS system, this probably won’t really change your treatment in the pre-hospital setting🚑 but understanding the physiology behind a patient’s condition, will allow us to be overall better providers.
Cor Pulmonale is a dysfunction of the right side of the heart💙 that is caused by 1. Something that causes damage to lung tissue (such as COPD💨 which is the #1 cause) 2. Something that damages pulmonary vessels (such as a Pulmonary Embolism) or 3. Something that prevents the lungs from fully expanding (such as Kyphosis!) Yes, an abnormal curvature of the spine can prevent the lungs from expanding appropriately, which can ultimately lead to vascular resistance and then pulmonary hypertension.
🫁Pulmonary HTN is what starts the domino effect.
Due to the ⬆️ pressure of the lungs, the blood from the RV meets resistance when trying to push through the pulmonary valve. This starts to cause slight back flow.
🫀The harder and harder the RV pushes, the more and more hypertrophy occurs.
Now the RV is unable to pump efficiently enough keep up with the demand of systemic circulation🔁. This starts to cause even more back flow.
[[ The ⬆️ pressure inside the RV, also compresses the coronary arteries that are perfuse that portion of the heart. (Coronary arteries are on the “outside” of the heart and provide perfusion to the heart muscle itself) The ⬇️ blood flow to the RV, causes ischemia which leads to further weakening of the RV. ]]
As the RV gets weaker and the the back flow builds up, it starts to have an effect on many other organs. It is responsible for complications such as cyanosis, edema and the increased vascular pressure, enlargement and dysfunction of many vital organs such as the liver and kidneys.
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