Cor pulmonale

.

1. Cor-pulmonale Ratheesh R.L

2. DEFINITION 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. Etiology 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

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

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

6. Clinical presentation 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

7. Clinical presentation 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

8. Clinical presentation tachypnea elevated jugular venous pressures hepatomegaly lower-extremity edema Cyanosis is a late finding

9. Clinical presentation Chronic wet cough Chest discomfort Bluish discoloration of skin Distention of neck veins Enlargement of liver

10. DIAGNOSIS 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

11. Echocardiogram: rt ventricular dialation and tricuspid regurgitation Cardiac catheterization

12. 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

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

14. MANAGEMENT PHARMACOTHERAPY DIURETIC AGENTS VASODIALATORS BETA SELECTIVE AGONISTS CARDIAC GLYCOSIDES THEOPHYLLINE WARFARIN

15. SURGICAL MANAGEMENT LUNG TRANSPLANTATION

16. Nursing management 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

17. 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.

18. NURSING DIAGNOSIS 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

19. NURSING DIAGNOSIS 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

20. NURSING DIAGNOSIS 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

21. NURSING DIAGNOSIS 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 o f dark circles around the eyes.