Hi, welcome to our respiratory
disorder video series.
In this one, we're gonna
take a look at cor pulmonale.
So let's start off with the obvious
question, what is cor pulmonale?
Well cor means heart think of
coronary so that'll remind you of heart,
pulmonale means lungs - pulmonary.
Now put those two terms together
and we have a very specific diagnosis.
Cor pulmonale is right-sided heart failure
it's caused by elevated pressure in the lungs.
Sso when you put cor pulmonale together, that
means the right side of the heart is struggling
and it's the lungs' fault.
So meet your tour guide.
Let's break that down, it should look smooth to you
he definitely look familiar to me from my childhood.
We're gonna use this figure to
kinda walk us through your tour guide.
Now here you see you have the lungs, you have
the heart and we're looking at the blood flow.
Blue is unoxygenated blood, red is oxygenated blood.
So you're starting with that the unoxygenated
blood returns to the heart on the right side.
Everybody is pretty familiar with that.
Now what is this, we have blue
coming up and blue coming down.
That's because unoxygenated blood comes
from down here and also comes down from up here.
So the unoxygenated blood is going back
to the heart on the right side, the right atrium.
So that's where the unoxygenated blood enters my heart
at the right atrium whether it's coming from here
or coming from here.
Now next, the unoxygenated blood move through
the tricuspid valve, that's the one on the right.
That's easier for me to remember
cause tri- sounds like "right",
so I always remember the right-sided valve is the
tricuspid valve and it heads into the right ventricle.
Now from there,the right ventricle is gonna move
that blood through the pulmonary artery to the lungs.
Now wait a minute, this is unoxygenated
blood, why do we call it the pulmonary artery?
Because arteries are vessels
that carry blood away from the heart
and since this is carrying blood away from the heart to
the lungs, that's why it's called the pulmonary artery.
So make sure you've got this traced.
Take a look at that, so I really want you to
even put your finger on the screen and follow that.
Follow the blood where it comes into the right
atrium through the valve what do we call that?
Right, the tricuspid valve then it
goes down into the right ventricle, okay.
From the right ventricle it spreads
out to both the right and the left lung,
The right ventricle is responsible for
pushing that blood to both of the lungs.
Now here's where it becomes a problem,
this is why cor pulmonale is cor pulmonale.
If there's damage to the lungs, either from
disease like COPD or some injury to the lungs
causes elevated pressures in the lungs or
pulmonary hypertension, now we've got a problem.
Okay, so you've got the right atrium,
tricuspid right ventricle out to the lungs.
Normally that should flow through, you
come back to the left atrium, mitral valve,
that left ventricle and out to the rest of
the body, but we've got a problem in between.
When it goes to the lungs and those pressure are
elevated, we're calling that pulmonary hypertension.
That's meaning the pressure in
the lungs' blood supply is really high.
Just like when we check your systemic blood
pressure,you check with a cuff on the patient's arm,
We're talking about the same
pressures in the lungs are up.
What are the causes?
Well disease or injury, most often it is
disease like COPD could be the cause.
So now the right ventricle has to work harder.
So it's gonna kinda step up because that right ventricle is
pushing up blood through the pulmonary artery into the lungs.
Once it pumps it through there, there's
been damaged it's got to work a lot harder.
So a normal heart, you look at that, has that
normal sized walls, everything looks consistent.
It can pump and be consistent, blood flows very
smoothly right? into the heart, out of the heart,
through the lungs, everything's good.
But with pulmonary hypertension, that right ventricle
has to work extra hard to overcome the increase
in the pulmonary blood pressure.
So all of a sudden, that right
ventricle's like. "woah, what is going on?"
It really has to start working harder, so
the right ventricle starts to get a little thicker
because it's becoming enlarged to try to
compensate for those elevated pulmonary pressures.
Initially, that's a good thing and the patient
really doesn't experience any symptoms.
Then it becomes stiff and ineffective because
it hypertrophies and it's no longer as helpful.
Sothe heart can't pump strong enough
to keep a good balance of fluid volume
so fluid volume begins to back up.
Now, think through that.
If it's in the right ventricles, no longer able to
push blood through to the lungs, what's gonna happen?
Let's talk about it, let's rewind and talk
about what right-sided heart failure looks like.
Remember that normally, the blood in the right ventricle
is pushed through the pulmonary artery into the lungs.
Now because of that hypertension,
it causes blood to back up into what?
Well, right back into that right ventricle.
Then it's gonna back up into right, to the
right tricuspid valve and into the right atrium.
Then the blood is gonna back up
into the body's veins and cause edema.
So it's gonna back all the
way back out the way it came in.
That's how we're looking at
right-sided congestive heart failure.
Now how will the patient feel?
Fatigue's an obvious one, right-sided,
left-sided, you've got fatigue.
What about increased peripheral pressure?
Well, because you have this all backing up,
now the pressure is increased in the periphery
and that's why you end up having edema, fluid ends
up leaking out of the blood vessels into the tissues.
So you can have ascites,
that's fluid leaking in the gut.
You might have a really big liver and a spleen.
You're gonna have distended jugular veins because
remember everything is backing up out here.
You're not really gonna feel like eating
because all of this is kind of big and bloaty.
You're gonna have weight gain because
you have extra fluid volume on board
and you're gonna have dependent edema,
that means their lower extremeties particularly
are gonna be edematous or swollen.
Remember, hgher pressure in the
peripheries, that's gonna cause more fluid volume
to go out into the tissues, that's
what causes a peripheral edema.