Classification of chronic cor pulmonale

Chronic cor pulmonale is not an independent disease, but a dangerous complication of other ailments. If it is not treated in a timely manner, the person may die.

Many patients suffering from bronchopulmonary or vascular diseases do not suspect that they may develop such a dangerous complication as chronic cor pulmonale (CHP).

This pathological condition is characterized by a strong increase in the right side of the heart, which is responsible for blood flow in the lungs.

But how does this disease manifest itself and why can it develop?

Manifestation of a pathological condition

The disease does not appear immediately, its symptoms increase gradually and are characterized by:

• shortness of breath. At first, this symptom increases with physical exertion, but then, as the pathology progresses, it begins to appear at rest. The main sign of enlargement of the right side of the heart is that the dyspnea decreases when the patient lies down;
• pallor or blueness of the skin. It is more often noted on the lips, tips of the nose and ears, on the feet;
• swollen neck veins. Venous pulsation in the neck becomes noticeable even with an external examination, and pulsation does not depend on breathing;

• prolonged agonizing cough. Persistent cough is unproductive, with it a small amount of rusty sputum is separated, but this does not bring relief to a person. In severe cases, coughing may cause pulmonary bleeding;
• chest pains. But they do not look like pain during a heart attack and are often associated with diseases of the esophagus or stomach in patients;
• apathy and weakness. With this pathology, people quickly get tired, experience constant drowsiness and complete indifference to the events taking place around them;
• feeling of abnormal heart rhythm. The enlarged right ventricle and atrium cannot fully contract, and the organ is forced to work with greater force;
• hypothermia. Due to the violation of full blood circulation, the body temperature decreases;
• hypotension. Lowering blood pressure is associated with a violation of normal blood circulation.

How pathology develops

The right ventricle is responsible for pumping blood through the pulmonary circulation.

When, for various reasons, free blood flow is disturbed in the pulmonary arteries and veins, the following occurs:

• The concentration of oxygen in the blood decreases, the content of carbon dioxide increases. Such a change in the blood is called hypercapnia (a mild form of hypercapnia is possible with respiratory infections, but it does not cause pathological changes and the heart does not require treatment).
• When signs of hypercapnia appear, protective mechanisms are activated, forcing the ventricle to contract with greater force to accelerate pulmonary blood flow.

• Blood through the pulmonary vessels begins to flow with great pressure, and signs of overload of the right ventricle gradually begin to develop. Its wall becomes thicker and denser, and the cavity increases. At this stage, patients may experience only mild respiratory discomfort during exercise or may be asymptomatic.
• Gradually, an increase in the right ventricle leads to the fact that the atrium has to contract with greater force for blood filling. Which leads to an increase in its size.

But an increase in the thickness of the myocardium leads to a violation of the conduction of contractile impulses and a decrease in contractility: then decompensated chronic pulmonary heart develops.

It can provoke a violation of the functioning of all vital systems and organs.

How are right heart lesions classified?

Officially, doctors for chronic cor pulmonale have developed a classification depending on the causes of the pathological condition:

• violation of alveolar air exchange;
• decreased ventilation of the lungs;
• vascular lesions of the pulmonary arteries.

Violation of air exchange

This group includes conditions in which the full flow of air to the alveoli is disturbed.

It could be:

• mechanical obstruction (bronchospasm during an asthma attack or the occurrence of bronchiectasis);
• inflammation of the respiratory tract (bronchitis, tuberculosis, chronic pneumonia);
• a change in the structure of the lung tissue (with sarcoidosis or systemic lupus erythematosus, the lung tissue is replaced by fibrous tissue, unable to perform the respiratory function).

Chronic cor pulmonale is most often caused by a violation of air exchange and appears as a complication of bronchopulmonary diseases (in about 80% of cases).

Decreased ventilation

This condition is caused by a violation of the excursion of the chest, when a person cannot fully breathe.

It can be called:

• changes in the skeleton of the chest (various deforming processes in the ribs and thoracic spine);
• adhesive processes in the pleura;
• decrease in the respiratory reflex (neuromuscular impulse conduction is disturbed and the depth of breathing decreases, this is possible with poliomyelitis and other diseases that affect the parasympathetic nervous system);
• operations on the chest, in which hypoventilation of the lungs was artificially induced.

Vascular disorders

Aneurysms, angiomas, thromboses and other factors that interfere with normal blood flow cause stagnation in the vessels of the lungs and prevent full gas exchange. Chronic cor pulmonale, which has arisen due to vascular disorders, is often complicated by pulmonary edema.

Diagnostic features

On examination, the doctor may see:

• strong blush on the cheeks (dilated skin vessels). The presence of a blush, even with severe right ventricular failure, is a hallmark of this pathology;

• redness of the eyes. The “rabbit eye” symptom can also occur with advanced forms of hypertension, when multiple retinal hemorrhages occur, but it is more typical for cardiopulmonary insufficiency;
• cyanosis of the mucous membranes of the mouth, lips and fingertips;
• "Drumsticks". Deformation of the nail phalanges, when they thicken and the nails become almost flat. This symptom occurs only in chronic cor pulmonale.

To clarify the diagnosis, such patients are assigned additional examinations:

1. ECG. The recorded tape will show signs of right ventricular hypertrophy.
2. X-ray. An x-ray will show an increase in the pattern of the lungs, expansion of the lymphatic vessels and bulging of the aorta. With pronounced hypertrophic changes, the contours of the heart shift to the right.
3. Ultrasound and dopplerography. With the help of these examinations, it is possible to determine the degree of thickening of the myocardium, as well as the speed and uniformity of blood flow (Dopplerography can detect the presence of an aneurysm or vasoconstriction).
4. CT scan. Even if the size of the organ has not yet been changed, a tomographic examination will reveal a deflection of the interventricular septum to the left due to increased pressure in the right ventricle. CTG data most fully allow to determine the degree of changes in the organs.
5. Spirography. The study of respiratory function helps to determine the degree of cardiopulmonary insufficiency.

In difficult cases, pressure is measured in the arteries of the pulmonary circulation.

Disease prognosis

Prediction depends on what pathological changes have occurred in the vessels and myocardium:

1. If the overload of the right ventricle is detected in the early stages and treatment is started in a timely manner, then the prognosis is favorable when the provoking factor is eliminated (treatment of the underlying disease) and hypertension in the small circle is reduced. Such patients, with constant medication and adherence to medical recommendations, can achieve long-term remission with periods of slight deterioration in well-being.
2. With the severity of changes in the myocardium with the development of a decrease in contractile function against the background of progression of respiratory failure, the prognosis is unfavorable. Even with ongoing maintenance therapy, 45% of patients die within 2 years. Only donor lung transplantation and angioplasty of small vessels give a chance for survival, but due to the weakened body of the patient, surgical treatment is not always successful and postoperative complications often occur.

Fatigue, shortness of breath or chest pain should not be ignored - a timely examination will help to identify the disease at an early stage, and the treatment started will prevent the occurrence of serious complications.