Definition

Cor pulmonale is a condition of right heart failure (RHF) caused by disorders or abnormalities in the lungs. Acute cor pulmonale is caused by acute lung disorders, such as pulmonary vascular problems.

The heart is an important part of the human circulatory system. The heart contains four chambers: the left and right ventricles, as well as the left and right atriums. Between these chambers, there are valves that ensure that the blood does not return to its previous location and flows in the correct direction.

In simple terms, blood from the entire body that contains a small amount of oxygen enters the right atrium (RA) and then the right ventricle (RV). From there, the blood will be pumped to the lungs through a vein. In the lungs, the blood will be enriched with oxygen and will enter the left atrium (LA) through a return blood vessel. After entering the LA, oxygen-rich blood will go to the left ventricle (LV), where it is pumped to the rest of the body.

If there is a disturbance or abnormality in the lungs, the blood vessels that carry blood to the LA may experience an increase in pressure because the RV must push harder in order for blood to enter the LA. This condition causes the RV to work harder. When the RV fails to compensate properly, it leads to right heart failure.

Acute cor pulmonale must be treated properly and immediately. If not treated properly, it can lead to death.

Causes

Acute cor pulmonale occurs due to abnormalities or disorders of the pulmonary blood vessels, such as a blockage. This condition occurs when a blood clot is released and flows in the bloodstream, which then clogs the blood vessels in the lungs. This blockage of blood vessels in the lungs will cause damage to the lungs. The damage will be even more fatal if the clot is large in size.

In addition, acute cor pulmonale can also occur as a complication of fluid accumulation in the air sacs in the lungs. This condition is also known as acute respiratory distress syndrome (ARDS).

Risk Factors

Several factors can increase the risk of acute cor pulmonale, including:

• Inhaling substances that irritate the lungs
• Having a head, chest, or other severe injury that causes direct damage to the lungs or to the part of the brain that regulates breathing, such as asbestos
• COVID-19
• A family history that increases the chance of blood clots forming in the lungs
• History of previous blood clots
• History of severe pneumonia
• Obesity
• Genetic or inherited traits from the family

Symptoms

The symptoms of acute and chronic cor pulmonale tend to be similar. Some of the symptoms that appear in acute cor pulmonale include:

• Rapid breathing (especially when resting)
• Feeling tired
• Swelling of the ankles
• Cough that gets progressively worse
• Shortness of breath
• Chest discomfort
• Coughing up blood
• Dizziness
• Voice hoarseness

Diagnosis

The doctor will ask several questions related to your symptoms and the possibility of acute cor pulmonale. In addition, the doctor will also perform a physical examination to determine any abnormalities in the heart and lungs.

Furthermore, the doctor will perform a supporting examination to help make a diagnosis. Some of the supporting examinations that may be performed include:

• Electrocardiogram (ECG)

This test involves attaching electrodes to your chest, legs, and hands. It will then give you a picture of your heart's electrical activity.

• Chest X-ray

This examination is done to help your doctor see the condition of your lungs and heart using X-rays.

• Cardiac MRI

This examination is done to determine the condition of your heart and provides a more specific picture, in the form of size, shape, and structure, and can detect signs of inflammation in the heart. This examination is mainly done in cases of inflammation of the outer heart or pericarditis and inflammation of the middle heart or myocarditis.

• Cardiac Catheterization

This examination is done by inserting a catheter through a blood vessel in the neck or leg which will then go to your heart. This is done to check for any abnormalities in your heart.

Management

When treating acute cor pulmonale, doctors will first address the underlying disease. The primary goal of treatment in this case is to improve oxygenation and cardiac function, particularly in the right ventricle. Treatment includes medications to lower blood pressure and increase oxygen flow to the lungs, medications to prevent blood clots, medications to remove excess fluid from the body, and oxygen therapy. In some severe cases, the doctor may recommend surgery, such as a heart or lung transplant.

Aside from recommending medical treatment, the doctor will also advise you to live a healthy lifestyle, quit smoking, and lose weight if overweight.

Complications

Acute cor pulmonale can lead to various complications, such as enlargement of the pulmonary blood vessels, thickening of the right ventricle wall, excess fluid in the body, and severe shortness of breath. If not treated quickly and appropriately, acute cor pulmonale can lead to death.

Prevention

Several things can be done to prevent the occurrence of acute cor pulmonale, namely by preventing the occurrence of the underlying disease and maintaining a healthy lifestyle, quitting smoking, losing weight, and avoiding exposure to substances that irritate the lungs. Exposure to lung irritants tends to occur in the workplace. Therefore, you should wear personal protective equipment to avoid such exposure. If you have certain medical conditions, such as blood clotting disorders and kidney disease, have your condition regularly monitored by your doctor.

When to See a Doctor?

If you experience symptoms as described above, immediately visit your doctor.

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