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The heart and lungs work together as a team to supply the body with oxygen. When one system is damaged by disease, it’s not uncommon for the other to be affected, as well. This is especially evident in COPD and a heart condition known as cor pulmonale.
Cor pulmonale is a common type of heart disease. In 1963, the World Health Organization defined it as enlargement of the right ventricle (lower chamber of the heart) resulting from diseases affecting the function and/or structure of the lungs, except when these lung alterations are the result of diseases that primarily affect the left side of the heart, as in congenital heart disease.1 Although the classical definition of the disease has since evolved, one factor remains the same: long-term, high blood pressure in the arteries of the lungs and right ventricle (also known as pulmonary hypertension or PH) is ALWAYS the underlying cause of right ventricle enlargement in cor pulmonale and may lead, in time, to right-sided heart failure.2
Cor pulmonale can range in severity from mild functional changes in the right ventricle to complete failure of the right side of the heart.3 Although any long-term lung condition that causes a prolonged decrease of oxygen in the blood can cause it, COPD accounts for approximately 80-90% of all cases.2
COPD can significantly affect heart function, damaging the right and left sides of the heart, and the blood vessels of the lungs. When heart function is impaired, it can alter the course of COPD, decreasing quality of life and shortening the life span.1
In the initial stages of the disease, shortness of breath with activity and lightheadedness are common. Your heart rate may increase, or you may feel like your heart is pounding. As the disease worsens, the following symptoms may occur with lighter activity, or even while you’re resting:4
In order to treat cor pulmonale effectively, your doctor will need to treat the underlying causes of your PH. Thankfully, a wide-variety of medications are available for PH, including vasodilators (promote relaxation of blood vessels), diuretics (water pills), inotropes (increase force of heartbeat), theophylline (relaxes airways), blood thinners, and oxygen therapy.
Because chronic low oxygen levels play a starring role in the development of PH, one of the most important treatment recommendations for COPD patients with cor pulmonale is continuous, long-term oxygen therapy (LTOT). Since oxygen acts like a vasodilator, it relaxes the arteries in the lungs, resulting in reduced pressure in the pulmonary artery. Studies confirm that LTOT used for at least 15 hours a day can prevent the progression of PH in a high percentage of patients with severe COPD.2 It can also increase survival.5
If you’re a COPD patient with PH or cor pulmonale, your doctor may have already prescribed LTOT. If so, that’s great! If not, see your health care provider as soon as possible to discuss your symptoms, as well as your treatment options for each condition, whether alone or combined.
Author: Deborah Leader RN, BSN, PHN