Cor pulmonale

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Classification according to ICD-10
I26.0 Pulmonary embolism with indication of an acute cor pulmonale
I27.0 Primary pulmonary hypertension
I27.1 Kyphoscoliotic heart disease
I27.2 Other specified secondary pulmonary hypertension
I27.9 Pulmonary heart disease, unspecified
ICD-10 online (WHO version 2019)

Cor pulmonale ( Latin ; "lung heart") describes a pressure-loaded right heart in medicine as a result of an increase in pressure in the pulmonary circulation ( pulmonary hypertension or secondary pulmonary hypertension), if the cause is to be found in the lungs and not in the heart. This increase in pressure can have various causes, from pulmonary embolism to chronic obstructive pulmonary disease ( COPD ) to the worm disease schistosomiasis, which is common worldwide . This means that the therapy options for cor pulmonale are so different that the term is used less and less and the more modern nomenclature of pulmonary hypertension (see there) is used instead .

Classification

A distinction is made between an acute cor pulmonale with an acute right-hand load and a chronic cor pulmonale with a hypertrophied right ventricle. Further classifications can be made according to the severity and the triggering causes.

causes

P-pulmonary ECG at rest in a patient with acute pulmonary embolism with right heart strain.

The right heart is stressed by high blood pressure in the small circulation. This pulmonary high pressure is caused by a pulmonary embolism or other lung diseases such as COPD, emphysema , pulmonary fibrosis , pleural rinds , kyphoscoliosis , sarcoidosis or cystic fibrosis . The consequence of the lung disease is an increased resistance of the pulmonary circulation. The increase in resistance is caused by constriction of the pulmonary arteries or by a reduction and obliteration (rarefication) of pulmonary vessels. The most common cause of chronic cor pulmonale is chronic obstructive bronchitis, which is usually associated with obstructive pulmonary emphysema.

Symptoms

In milder cases of chronic cor pulmonale, symptoms may be absent at rest. Otherwise, the main symptom is shortness of breath under exertion ( exertional dyspnea ) or already at rest ( resting dyspnea ) . Other symptoms can include chest pressure, central cyanosis , secondary polyglobulia , hypertrophic osteoarthropathy , tachycardia , right heart failure , respiratory acidosis, and caliber skip .

In severe acute cor pulmonale z. B. as a result of a pulmonary embolism it comes to shortness of breath, pallor and cyanosis. It occurs circulatory shock in which to complete right heart failure and can lead to death.

Diagnosis

Diagnostics include measuring oxygen saturation , making an EKG , a chest x-ray and heart ultrasound (echocardiography)

The ECG changes typical are a P pulmonale, an abnormal right deviation of the P-vector of the SI QIII- layer type , a left-shifted R / S transition, as well as a ball type to right type and a right delay in branch block .

Echocardiography can show, among other things, a thickened wall of the right ventricle in the subcostal section, an enlargement of the right atrium and the right ventricle, tricuspid regurgitation and congested hepatic veins .

For more precise diagnostics, e.g. B. in acute cor pulmonale, a computed tomography of the chest with contrast agent is carried out on the question of pulmonary embolism . In addition, a pressure measurement using a right heart catheter examination may be necessary. Other useful examinations are pulmonary function tests and spiroergometry .

therapy

  • Treatment of the underlying lung disease
  • Treatment of pulmonary embolism
  • Oxygen administration, also as long-term therapy
  • Ventilation
  • Pressure reduction in the small circuit

literature

  • D. Palitzsch (Ed.): Adolescent Medicine. Urban & Fischer, 1999, ISBN 3-437-41230-2 , p. 375.
  • The Merck Manual of Diagnosis and Therapy: Cor Pulmonale.
  • M. Dietel, J. Dudenhausen, N. Suttorp (Eds.): Harrison's internal medicine. 15th edition. ABW Wissenschaftsverlag, McGraw-Hill 2001, ISBN 3-936072-10-8 .
  • J. Apitz (Ed.): Pediatric Cardiology. Heart diseases in newborns, infants, children and adolescents. 2nd Edition. Steinkopf, 2002, ISBN 3-7985-1322-8 , p. 487.
  • Gerd Herold: Internal Medicine. 2016.

Individual evidence

  1. ^ W. Pschyrembel: Clinical dictionary. 265th edition. Verlag Walter de Gruyter, 2014, ISBN 978-3-11-018534-8 .
  2. ^ Herbert Reindell , Helmut Klepzig: Diseases of the heart and the vessels. In: Ludwig Heilmeyer (ed.): Textbook of internal medicine. Springer-Verlag, Berlin / Göttingen / Heidelberg 1955; 2nd edition, ibid. 1961, pp. 450-598, here: pp. 585-587 ( Das akute Cor pulmonale ).
  3. ↑ Reinhard Larsen: Anesthesia and intensive medicine in cardiac, thoracic and vascular surgery. (1st edition 1986) 5th edition. Springer, Berlin / Heidelberg / New York et al. 1999, ISBN 3-540-65024-5 , p. 481.

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