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Cor pulmonale or pulmonary heart disease is a change in structure and function of the right ventricle of the heart as a result of a respiratory disorder. Right ventricular hypertrophy (RVH) is the predominant change in chronic cor pulmonale, whereas in acute cases, dilation dominates. Both hypertrophy and dilation are the result of increased right ventricular pressure.
Dilation is essentially a stretching of the ventricle, the immediate result of increasing the pressure in an elastic container. Ventricular hypertrophy is an adaptive response to a long-term increase in pressure. Individual muscle cells grow larger and undergo characteristic morphologic changes to allow for the increased contractile force required to move the blood against greater resistance.
To be classified as cor pulmonale, the cause must originate in the pulmonary circulation system. Two major causes are vascular changes as a result of tissue damage (e.g., disease, hypoxic injury, chemical agents, etc.), and chronic hypoxic pulmonary vasoconstriction. RVH due to a systemic defect is not classified as cor pulmonale.
Left untreated, cor pulmonale can lead to right-heart failure and death.
There are several mechanisms leading to pulmonary hypertension and cor pulmonale:
Blood backs up into the systemic venous system, including the hepatic vein. Chronic congestion in the centrilobular region of the liver leads to hypoxia and fatty changes of more peripheral hepatocytes, leading to what is known as nutmeg liver.
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