Chronic cor pulmonale

The role of cor pulmonale in the pathogenesis of obstructive diseases

Chronic obstructive pulmonary disease triggers a cascade of irreversible changes in the body. The development of chronic cor pulmonale (cor pulmonale) is one of the most prognostically significant stages of this process. This pathology never develops in isolation. It occurs against the background of progressive respiratory failure and is accompanied by diffuse sclerotic processes in the pulmonary parenchyma. As sclerosis spreads to new areas of the lungs, vascular bed resistance inevitably increases.

Mechanism of cor pulmonale development

The pathogenesis is based on a strict sequence of events. Diffuse sclerotic processes in the lungs directly lead to the development of secondary pulmonary hypertension. Due to the persistent increase in pressure in the lesser circulation, the right ventricle of the heart faces colossal hemodynamic overload.

Trying to overcome the increased vascular resistance, the myocardium of the right heart activates adaptation mechanisms. Clinically and morphologically, this manifests as right ventricular hypertrophy. However, these compensatory reserves are not limitless. Over time, they become depleted, marking the transition of the disease to the decompensation stage with the development of severe cardiopulmonary failure.

Concomitant infectious and systemic complications

The course of cor pulmonale in chronic obstructive pulmonary disease is regularly complicated by the addition of secondary flora. Secondary infections rapidly develop against the background of impaired ventilation and bronchial drainage function. These include recurrent pneumonia and severe purulent processes.

The long-term presence of purulent inflammation foci in the lung tissue can trigger systemic metabolic disorders. In particular, this provokes the development of secondary amyloidosis—a systemic disease in which an abnormal protein (amyloid) is deposited in internal organs with predominant kidney involvement, leading to renal failure.

Life-threatening conditions and causes of death

Patients with chronic cor pulmonale are at high risk for developing several critical conditions. In addition to steadily progressing cardiopulmonary failure, significant threats include:

• Lung and bronchial cancer. Chronic inflammation and obstruction create a background for malignant transformation of the epithelium.
• Spontaneous pneumothorax. The pathology often proceeds with the formation of emphysema. The rupture of bullous emphysematous dilations leads to air entering the pleural cavity, which instantly excludes a part of the lung from the act of breathing and catastrophically increases the load on the right ventricle.

Class and exam questions

What else to study on this topic

• Mechanisms of progressive respiratory failure development
• Pathogenesis of secondary pulmonary hypertension in sclerosis
• Morphological characteristics of diffuse sclerotic processes
• Secondary renal amyloidosis: connection with purulent processes
• Spontaneous pneumothorax and rupture of bullous dilations

Other topics in the "Additional Topics" section

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