Cor Pulmonale
Right-heart strain caused by lung disease
Quick Facts
- Type: Heart and lung condition
- Underlying problem: High blood pressure in the lung arteries
- Common cause: Chronic lung disease such as COPD
- Key symptoms: Breathlessness, leg swelling, fatigue
Overview
Cor pulmonale is a condition in which the right side of the heart becomes enlarged and weakened because it has to pump against high blood pressure in the arteries of the lungs. The right side of the heart normally sends blood to the lungs to pick up oxygen; when the lung arteries are narrowed or stiff, this becomes much harder work.
Over time the strain causes the right side of the heart to thicken, enlarge, and eventually fail. Cor pulmonale is almost always a complication of another long-term lung or pulmonary blood vessel problem, so treating that underlying cause is central to managing it.
Symptoms
Early symptoms can be subtle and may be mistaken for the underlying lung disease. As the condition progresses, signs of right-heart strain appear.
- Shortness of breath, especially with exertion
- Fatigue and reduced exercise tolerance
- Swelling of the ankles, legs, or abdomen
- A bluish tinge to the lips or skin from low oxygen
- Chest discomfort or a racing or pounding heartbeat
- Fainting or lightheadedness with exertion
Worsening breathlessness, severe swelling, chest pain, or fainting are warning signs that need prompt medical attention.
Causes
Cor pulmonale results from conditions that raise the blood pressure in the lungs' arteries. Common causes include:
- Chronic obstructive pulmonary disease (COPD): The most frequent cause.
- Pulmonary hypertension: High pressure in the lung arteries from various causes.
- Long-term blood clots in the lungs (chronic pulmonary embolism).
- Interstitial lung disease and pulmonary fibrosis, which scar and stiffen the lungs.
- Severe obstructive sleep apnea and other conditions causing low oxygen.
Risk Factors
- Long-standing COPD or other chronic lung disease
- Smoking
- Pulmonary hypertension
- Recurrent or chronic blood clots in the lungs
- Untreated severe sleep apnea
- Living at high altitude for long periods
Diagnosis
Doctors diagnose cor pulmonale by assessing the heart and identifying the underlying lung problem. Tests may include:
- Echocardiogram: An ultrasound of the heart to assess the size and function of the right side and estimate lung artery pressure.
- Electrocardiogram (ECG): To look for signs of right-heart strain.
- Chest imaging: X-ray or CT scan of the lungs and heart.
- Blood tests and oxygen levels: To assess strain and oxygenation.
- Right heart catheterization: The most accurate way to measure lung artery pressure when needed.
Treatment
Treatment aims to relieve the strain on the heart and, crucially, to treat the underlying lung condition.
- Oxygen therapy: Long-term oxygen for people with low blood oxygen, which can reduce lung artery pressure.
- Treating the lung disease: Optimizing COPD, sleep apnea, clot, or pulmonary hypertension treatment.
- Diuretics: To reduce fluid buildup and swelling.
- Medications: Specific drugs that lower lung artery pressure in selected cases, and blood thinners when clots are involved.
- Lifestyle steps: Stopping smoking, staying active as advised, and limiting salt.
Prevention
- Do not smoke, and avoid secondhand smoke and lung irritants
- Treat lung conditions such as COPD and sleep apnea early and consistently
- Use prescribed oxygen and inhalers as directed
- Manage and prevent blood clots if you are at risk
- Keep up with vaccinations to avoid lung infections
When to See a Doctor
See a doctor if you have a chronic lung condition and notice new or worsening breathlessness, swelling in the legs or abdomen, or fatigue. Early treatment of the underlying cause can protect the heart.
Seek emergency care for severe shortness of breath, chest pain, fainting, a bluish color to the lips or skin, or coughing up blood, as these can signal a dangerous worsening that needs immediate treatment.
Frequently Asked Questions
What is cor pulmonale?
Cor pulmonale is enlargement and failure of the right side of the heart caused by long-term high blood pressure in the arteries of the lungs. The right heart has to work too hard to pump blood through diseased or constricted lung vessels and eventually weakens.
What causes cor pulmonale?
It is almost always a complication of another lung or pulmonary blood vessel problem. The most common cause is COPD, but pulmonary hypertension, chronic lung clots, scarring lung diseases, and severe sleep apnea can also lead to it.
What are the main symptoms?
Common symptoms include shortness of breath with exertion, fatigue, and swelling of the ankles, legs, or abdomen. A bluish tinge to the lips, chest discomfort, palpitations, or fainting can occur as it worsens.
Can cor pulmonale be treated?
Yes, though treatment focuses largely on the underlying lung disease. Oxygen therapy, diuretics for fluid buildup, optimizing treatment of conditions like COPD or sleep apnea, and sometimes medications that lower lung artery pressure all help.
When should I get emergency care?
Seek emergency care for severe shortness of breath, chest pain, fainting, a bluish color to the lips or skin, or coughing up blood. These can indicate a dangerous worsening of the heart or lung condition.
References
- MedlinePlus, U.S. National Library of Medicine. Cor pulmonale.
- National Heart, Lung, and Blood Institute (NHLBI).
- Cleveland Clinic. Cor Pulmonale.
- American Lung Association.