Why Right-Sided Heart Failure Is a Major Concern for People With COPD (2024)

Cor pulmonale occurs when the blood pressure in the pulmonary artery—which carries blood from the heart to the lungs—increases and leads to the enlargement and subsequent failure of the right side of the heart. It also can occur with chronic low oxygen levels due to conditions like chronic obstructive pulmonary disease (COPD).

Cor pulmonale symptoms can include fatigue, swelling, and chest pain. Cor pulmonale is a progressive condition that can rapidly worsen. If left untreated, it may be life-threatening.

This article explains cor pulmonale causes and how the condition is diagnosed. While there is no cure and cor pulmonale won't go away, a number of treatment options can help to improve symptoms.

Cor Pulmonale Symptoms

The early symptoms of cor pulmonale can go unnoticed because the causative lung disease also causes symptoms, and some effects may be similar. To make matters even more confusing, symptoms of cor pulmonale often develop as the underlying lung condition worsens.

Common effects of cor pulmonale include:

• Wheezing and coughing
• Intolerance of exercise or even mildly strenuous physical activity (like walking upstairs)
• General fatigue
• Shortness of breath (dyspnea)
• Dizziness
• Edema (swelling of the feet and/or ankles)

Cor Pulmonale Causes

This type of right-sided heart disease can develop slowly or suddenly, and it is always caused by lung disease. COPD is the most common cause of cor pulmonale, but there are others as well. Often, cor pulmonale is more severe if you also have other types of heart disease, such as an arrhythmia or a history of a heart attack.

Common causes of cor pulmonale include:

• Cystic fibrosis
• Sleep apnea
• Scleroderma of the lungs
• Pulmonary embolism (PE), or blood clot in the lungs
• Lung tissue damage
• Acute respiratory distress syndrome (ARDS)
• Interstitial lung disease (ILD)
• Lung cancer

Effect on the Heart

The heart has four chambers—left atria, left ventricle, right atria, and right ventricle. Cor pulmonale is right heart failure due to high pressure in the pulmonary arteries (arteries that lead from the heart to the lungs). As this condition develops, the right ventricle becomes dilated (widened) and thickened, and later the right atrium may be affected as well.

How Is Cor Pulmonale Diagnosed?

The diagnosis for cor pulmonale is usually made in the healthcare provider’s office. A physical exam typically picks up any abnormal heart sounds or rhythm, fluid retention, or protruding neck veins.

To provide a definitive diagnosis, your healthcare provider may also perform the following tests:

• Echocardiogram, which uses sound waves to visualize the heart
• Chest X-ray
• Computed tomography (CT) scan of the chest
• Arterial blood gases (ABG) blood test

Pulmonary artery catheterization, with the insertion of a catheter into the pulmonary artery to check for heart failure, also can be done. A scan to check for ventilation/perfusion (VQ) mismatch, which uses radioactive materials to examine the airflow and blood flow into the lung, also can be done.

Cor Pulmonale Treatment

Treatment for cor pulmonale is focused on addressing the underlying illness. There are also a few treatments that can alleviate some effects of heart failure.

Management of the underlying lung condition can include:

• Bronchodilators
• Steriods
• Mucolytics
• Antibiotics if you have a lung infection
• Blood thinner or interventional procedure for the management of a PE

The use of calcium channel blockers is complicated when it comes to cor pulmonale. These drugs preventcalciumfrom entering the cells of blood vessel walls and may relax the pulmonary arteries, reducing pulmonary hypertension, but they may also adversely affect the heart and respiratory function in some instances.

Treatments aimed at alleviating the effects of cor pulmonale include:

• Oxygen therapy
• Anticoagulants (blood thinners), which may decrease mortality in persons with pulmonary hypertension
• Beta-blockers to improve heart function
• Diuretics, such as spironolactone, or renin-angiotensin system inhibitors to reduce edema
• Cholesterol-lowering agents to reduce the risk of blood clots

A heart transplant may be considered in very advanced cases, and a lung transplant may be considered for some types of lung disease. Keep in mind that pulmonary hypertension associated with cor pulmonale has negative impact on life expectancy.

Summary

Cor pulmonale is a serious heart condition that develops as a complication of advanced lung disease, most often COPD. Symptoms include increasing shortness of breath with exertion, chest pain, dizziness, and a bluish tinge to the skin (cyanosis).

Treatment can include supplemental oxygen, and a number of medications to protect against blood clots and improve heart function and blood flow.

Because there is no treatment that can reverse cor pulmonale, prevention is key. Strategies for prevention include avoidance of smoking and airborne pollution as well as careful management of your lung disease. Talk with your healthcare provider if you have concerns about cor pulmonale.

By Deborah Leader, RN
Deborah Leader RN, PHN, is a registered nurse and medicalwriter who focuses on COPD.