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1. Ratheesh R.L

2.  It is the failure of the right side of the heart
caused by prolonged high blood pressure in the
pulmonary artery and right ventricle of the
heart.
 Pulmonary hypertension is usually a pre-
existing condition in the individual with cor
pulmonale.
 It is also known as right side heart failure.

3.  develops in response to acute or chronic
changes in the pulmonary vasculature
 Changes that are sufficient to cause
pulmonary hypertension
 Once patients with chronic pulmonary or
pulmonary vascular disease develop cor-
pulmonale, their prognosis worsens

5.  Several pathophysiologic mechanisms can lead to pulmonary
hypertension and subsequently to cor- pulmonale.
 These pathogenic conditions include,
1. Pulmonary vasoconstriction due to alveolar hypoxia.
2. Anatomic compromise of the pulmonary vascular bed
secondary to lung disorder such as emphysema and
pulmonary thromboembolism.
3. Increased blood viscosity in case of sickle cell anemia.
4. Pulmonary hypertension

6. Pulmonary Vessel
Restriction
Hypoxia
H
Hypercapnea
A
Acidemia
Anatomic changes
Chronic Cor Pulmonale
Rt. Ventricular Failure
Increased
Viscosity Pulmonary thrombo-
embolimPULMO.NARY HTN

7.  Dyspnea, the most common symptom:
 usually the result of the increased work of
breathing secondary to changes in elastic
recoil of the lung (fibrosing lung diseases) or
altered respiratory mechanics
 Orthopnea and nocturnal dyspnea are
rare symptoms of right HF
 reflect the increased work of breathing in
the supine position that results from
compromised excursion of the diaphragm

8.  Tussive or effort-related syncope
 because of the inability of the RV to deliver blood
adequately to the left side of the heart
 Abdominal pain and ascites
 Lower extremity edema
 Shortness of breath
 wheezing

9.  tachypnea
 elevated jugular venous pressures
 hepatomegaly
 lower-extremity edema
 Cyanosis is a late finding

10.  Chronic wet cough
 Chest discomfort
 Bluish discoloration of skin
 Distention of neck veins
 Enlargement of liver

11.  History collection
 Physical examination
 ECG ( prominent R wave and inverted T wave)
 Chest X Ray
– enlargement of the main pulmonary artery and the
descending right pulmonary artery andRt ventricular
hypertrophy

12.  Echocardiogram: rt ventricular dialation and
tricuspid regurgitation
 Cardiac catheterization

13.  Doppler echocardiography
 assess pulmonary artery pressures
 MRI scan
 assessing RV structure and function, particularly
in patients who are difficult to image with
echocardiography because of severe lung disease

14. – Adequate oxygenation (oxygen saturation 90–92%) will
also decrease pulmonary vascular resistance and reduce
the demands on the RV.

15.  PHARMACOTHERAPY
• DIURETIC AGENTS
• VASODIALATORS
• BETA SELECTIVE
AGONISTS
• CARDIAC GLYCOSIDES
• THEOPHYLLINE
• WARFARIN

16.  LUNG TRANSPLANTATION

17.  Instruct the patient to take all medicines on
prescribed time.
 Encourage to use low sodium diet
 Instruct to drink more water
 Instruct the patient to maintain proper body weight
 Teach the patient to balance activity and rest
 Instruct the patient to avoid vigorous activities and
exercises

18.  Encourage to perform stress reduction
activities.
 Teach about breathing and coughing exercise
 Suggest the family members to learn about
CPR.
 Check the oxygen saturation level inbetween
 Provide nebulization and chest physiotherapy.
 Maintain proper blood pressure
 Obtain the lipid profile frequently
 Provide psychological support to the patient
and relatives.

19.  Decreased cardiac output related to
restricted cardiac muscle contractility as
evidenced by echocardiographic finding
 Impaired gas exchange related to expiratory
airflow obstruction as evidenced by
decreased oxygen saturation levels

20.  Impaired tissue perfusion related to decreased
cardiac contractility and expiratory airflow
obstruction as evidenced by increased capillary
refilling time >3 seconds
 Activity intolerance related to decreased cardiac
activity and laboured respirations as evidenced
by difficulty in performing activities of daily
living

21.  Fatigue related to decreased cardiac
activity and laboured respirations as
evidenced by difficulty in performing
activities of daily living
 Anxiety related to breathlessness as
evidenced by patient`s verbalization and
facial expressions

22.  Imbalanced nutrition :less than body
requirement related to breathlessness as
evidenced by weight loss
 Disturbed sleep pattern related to
shortness of breath as evidenced by
presence of dark circles around the eyes.