OVERVIEW

Are there many patients with chronic cor pulmonale?

Chronic cor pulmonale, commonly known as "pulmonary heart disease," is a prevalent and frequently occurring condition in China, with an incidence rate of approximately 0.44%. In other words, there are at least 5 million chronic pulmonary heart disease patients in China.

It is characterized by higher prevalence rates in colder regions compared to warmer areas, in high-altitude regions compared to plains, in rural areas compared to urban areas, and among smokers compared to non-smokers. Acute episodes are more common in winter and spring, with acute respiratory infections often being the trigger for acute onset.

SYMPTOMS

What manifestations may occur in chronic cor pulmonale?

With the above risk factors, along with long-term (more than 3 months) symptoms of lung disease such as cough, sputum production, shortness of breath, palpitations after activity, difficulty breathing, fatigue, and reduced exercise tolerance—worsening after a cold, and a faster resting heart rate (usually over 90 beats per minute)—

one should be highly alert to the possibility of cor pulmonale. Prompt chest X-rays, cardiac ultrasound, and electrocardiograms can detect early signs of cor pulmonale, allowing for timely prevention.

What typical manifestations occur in severe cases of chronic cor pulmonale?

It mainly presents symptoms of respiratory failure and right-sided heart failure.

• Respiratory failure: Increasing difficulty breathing, especially at night, often accompanied by headaches, insomnia, daytime drowsiness, apathy, and confusion due to hypoxia.

• Right-sided heart failure: Palpitations, tachycardia, chest tightness, and other cardiac discomforts, as well as symptoms caused by systemic venous congestion—such as reduced appetite, nausea, and bloating (due to gastrointestinal congestion); dizziness, memory decline, and jugular vein distension (due to head congestion); and lower limb edema (due to impaired venous return).

Why do chronic cor pulmonale patients often show polycythemia in blood tests?

When lung function declines, insufficient oxygen intake leads to hypoxia. The body mistakenly believes there are not enough "oxygen trucks" (red blood cells), so it overproduces them through regulatory mechanisms, resulting in polycythemia. While this may temporarily alleviate hypoxia, it also increases blood viscosity, further elevating pulmonary artery pressure.

Why does right atrial enlargement occur early in chronic cor pulmonale?

Clinically, many patients with chronic lung disease first exhibit right atrial enlargement while heart function is still compensatory, with the right ventricle showing only mild hypertrophy or remaining normal.

This is because the right atrial wall is thinner than the right ventricular wall. Increased pulmonary artery pressure raises right ventricular pressure, but the weaker right atrium is the first to struggle with blood flow into the ventricle—like blowing up a balloon, the thinnest part expands first. Enlarged right atria appear as tall, peaked P waves ("P pulmonale") on ECG.

Why are chronic cor pulmonale patients more prone to colds?

Chronic lung diseases severely weaken respiratory defenses. Hypoxia also reflexively triggers sympathetic overactivity, releasing catecholamines that constrict pulmonary arteries, further reducing lung defenses.

Recurrent upper respiratory infections worsen lung disease, forming a vicious cycle and serving as the primary trigger for cor pulmonale exacerbations.

How can pulmonary encephalopathy be detected early in chronic cor pulmonale patients?

When symptoms worsen from stable to acute (e.g., due to infection), pulmonary encephalopathy risk rises.

If family members notice mental abnormalities—sudden sluggishness, excessive sleepiness, confusion, or memory lapses—they should provide low-flow oxygen and seek immediate medical help. Call 120 for nighttime emergencies.

Why are cor pulmonale patients prone to atrial fibrillation?

Right atrial enlargement disrupts electrical activity, increasing risks of atrial fibrillation, flutter, or tachycardia—like earthquake-damaged wiring causing short circuits.

Radiofrequency ablation is often ineffective for persistent AF in these patients; focus remains on thromboprophylaxis.

Why do chronic cor pulmonale patients have facial flushing?

Chronic respiratory dysfunction causes CO₂ retention, dilating peripheral blood vessels and leading to facial flushing and conjunctival redness.

Home oxygen therapy helps relieve symptoms, while daily pursed-lip breathing exercises can prevent CO₂ buildup.

CAUSES

What kind of lung diseases can lead to cor pulmonale?

When any lung disease (including tracheal diseases) obstructs blood flow into the pulmonary arteries, pulmonary artery pressure increases, placing a greater burden on the right ventricle. Over time, this can lead to right ventricular hypertrophy, dilation, or even right heart failure, a condition known as cor pulmonale.

In simple terms, if the "loading dock" (lungs) malfunctions, "trucks" (blood) can't enter, causing severe congestion on the "highway" (pulmonary artery). The pressure skyrockets, overloading the "dispatch center" (right ventricle). Prolonged dysfunction results in cor pulmonale.

Besides lung diseases, what other conditions can cause chronic cor pulmonale?

• Severe thoracic deformities: Conditions like pectus carinatum or rickets compress the lungs, impairing ventilation and blood circulation, ultimately raising pulmonary artery pressure and causing right ventricular changes that lead to cor pulmonale.

• Pulmonary vascular diseases: Primary pulmonary hypertension (of unknown cause) or pulmonary arteriolitis increase pulmonary vascular resistance, eventually overloading the right ventricle and causing cor pulmonale.

• Other diseases: Such as sleep apnea syndrome or neuromuscular disorders.

What is the relationship between chronic cor pulmonale and sleep apnea syndrome?

Sleep apnea syndrome involves severe snoring and breathing pauses during sleep, drastically reducing oxygen intake. With "less cargo" (oxygen) but the same number of "trucks" (blood), the "loading dock" (lungs) restricts entry, while the "dispatch center" (heart) keeps sending "trucks," causing massive congestion on the "highway" (pulmonary artery). This leads to pulmonary hypertension, ultimately straining the right heart and resulting in cor pulmonale.

Who is more susceptible to chronic cor pulmonale?

• Long-term smokers: Smoking is undeniably the leading cause of lung diseases, significantly increasing the risk of cor pulmonale.

• Occupational dust exposure: Miners, construction workers, and cement workers exposed to dust for 10–20 years often develop irreversible pulmonary fibrosis and impaired lung function, leading to cor pulmonale by middle age.

• Climate factors: Northern populations have a higher incidence of cor pulmonale than southerners, as cold temperatures and sharp weather changes contribute to chronic bronchitis and eventual cor pulmonale.

• Air pollution: Long-term exposure to PM2.5 and smog is a major factor in chronic obstructive pulmonary disease (COPD).

• Genetic factors: Epidemiological studies suggest a genetic predisposition to COPD.

DIAGNOSIS

What tests are needed to diagnose chronic cor pulmonale?

• Chest X-ray: To detect signs of pulmonary infection, assess for pulmonary hypertension, and identify right heart enlargement;

• Pulmonary function tests: To evaluate for ventilation disorders and diagnose chronic obstructive pulmonary disease (COPD);

• Electrocardiogram (ECG): Important for detecting right heart changes;

• Echocardiography: Provides rapid assessment of atrial and ventricular dimensions;

• Arterial blood gas analysis: Determines hypoxia, carbon dioxide retention, and acid-base imbalance;

• Complete blood count (CBC): Identifies acute infection and guides antibiotic use.

How do doctors diagnose chronic cor pulmonale?

The diagnosis is made clinically based on underlying chronic lung, airway, bronchial diseases, or thoracic deformities, combined with symptoms, physical examination, and tests such as ECG, echocardiography, chest X-ray, and pulmonary function tests that reveal pulmonary hypertension and right ventricular hypertrophy or enlargement.

What are the characteristics of chest X-rays in chronic cor pulmonale?

Chest X-rays may show signs of elevated pulmonary artery pressure and right ventricular enlargement, including widening of the right descending pulmonary artery, convexity of the pulmonary artery segment, and right ventricular hypertrophy with upward displacement of the cardiac apex.

What regular outpatient tests should patients with chronic cor pulmonale undergo?

• Pulmonary function tests: Critical for monitoring changes in lung function;

• Complete blood count (CBC): Tracks red blood cell changes and detects occult infections through white blood cell variations;

• Arterial blood gas analysis: Assesses acid-base imbalance, hypoxemia, and carbon dioxide retention;

• Holter monitoring: Identifies arrhythmias such as atrial tachycardia, flutter, or fibrillation;

• Echocardiography: Monitors right atrial/ventricular changes and evaluates pulmonary artery pressure.

TREATMENT

How to treat chronic cor pulmonale?

• During remission, actively prevent respiratory infections, exercise to enhance immunity, and quit smoking;

• During acute episodes, actively control infections, administer low-flow oxygen, clear the airways, improve respiratory function, correct hypoxia and carbon dioxide retention, manage respiratory and heart failure, and address various complications.

Why should chronic cor pulmonale patients receive low-flow oxygen?

Unlike the oxygen therapy principle for left heart failure, cor pulmonale requires low-flow oxygen. This is because long-term carbon dioxide retention makes the respiratory center less sensitive to elevated CO2 levels, relying instead on hypoxia to maintain respiratory drive.

If high-flow oxygen rapidly corrects hypoxia, the stimulatory effect on the respiratory center disappears, increasing the risk of weakened breathing or even respiratory arrest.

Why is psychological care important for chronic cor pulmonale patients?

Due to prolonged illness and recurrent exacerbations, cor pulmonale patients often feel demoralized and lose confidence in treatment and life. Family members should communicate with them regularly, maintain a warm demeanor, accompany them in outdoor activities, and encourage exercise when possible to alleviate anxiety and fear while boosting their confidence in fighting the disease.

Sometimes, psychological care achieves effects unmatched by medication or other treatments.

Why isn’t correcting right heart failure the primary focus in treating chronic cor pulmonale?

For cor pulmonale patients with right heart failure, reducing cardiac load is the foundational treatment. Symptoms often improve or resolve after oxygen therapy, infection control, respiratory function enhancement, and correction of hypoxia and CO2 retention, so diuretics and cardiac glycosides are not routinely used.

If symptoms persist or worsen, diuretics and cardiac glycosides may be considered.

Why shouldn’t chronic cor pulmonale patients misuse diuretics?

Many patients self-administer diuretics for oliguria or leg edema, unaware this may worsen their condition. Potential mechanisms include:

• Diuretics cause fluid loss, thickening mucus and worsening airway obstruction and dyspnea, exacerbating infections and disease progression;

• Chronic cor pulmonale patients often have high hemoglobin and hypercoagulability; diuretics may worsen hemoconcentration, increasing deep vein thrombosis risk;

• Hyponatremia is common, and potent diuretics may worsen electrolyte imbalances, endangering life.

Thus, diuretics should only be used under specialist supervision.

Are there risks in using digitalis for chronic cor pulmonale?

Hypoxia in cor pulmonale increases cardiac sensitivity to digitalis, raising the risk of toxicity (e.g., arrhythmias or sudden death). Digitalis should only be considered in the following cases:

• Infection is controlled, respiratory function improved, but right heart function remains poor after diuretic therapy;

• Complicated by atrial tachycardia, flutter, or fibrillation (ventricular rate >100 bpm);

• Right heart failure is the main manifestation without acute infection;

• Complicated by acute left heart failure.

Note: Cardiac glycosides must be used under specialist guidance.

Why should β-blockers be avoided in chronic cor pulmonale patients?

While β-blockers (e.g., metoprolol) are common for heart failure, they must be used cautiously in cor pulmonale.

Even highly selective β1-blockers may cause dyspnea, bronchospasm, or asthma, especially in patients with preexisting lung disease.

Why is home oxygen therapy beneficial for chronic cor pulmonale?

Long-term home oxygen therapy not only corrects hypoxia and hypercapnia but also improves survival, quality of life, and mental state; reduces polycythemia and blood viscosity; enhances sleep and reduces drowsiness; boosts respiratory immunity; and prevents respiratory or right heart failure, significantly lowering mortality.

How long should chronic cor pulmonale patients use home oxygen daily?

Standard therapy requires ≥18 hours/day (continuous oxygen therapy). Nighttime-only use (10–12 hours) is termed nocturnal oxygen therapy.

Ideally, patients should receive ≥15 hours/day, including full-night use plus 2-hour sessions in the morning and afternoon.

Should chronic cor pulmonale patients be hospitalized in respiratory or cardiology departments?

For isolated cor pulmonale, respiratory departments are preferred—lung disease is the "cause," heart disease the "effect." Controlling lung disease improves cardiac function.

For patients with concurrent coronary or other heart diseases (primarily manifesting as heart failure), cardiology departments are better, with respiratory consultation if needed.

Can chronic cor pulmonale be cured completely?

Recurrent acute exacerbations progressively damage the heart, lungs, and vital organs. Though treatable, most cases have poor long-term prognosis.

Active treatment cannot reverse the disease but may delay progression, prolong life, and improve quality of life.

DIET & LIFESTYLE

What should patients with chronic cor pulmonale pay attention to in their diet?

• Cor pulmonale is a chronic disease. Like other heart disease patients, sodium intake should be limited to reduce cardiac load and prevent edema.

• Patients are encouraged to consume a high-protein, high-calorie, and vitamin-rich diet to improve immunity, while avoiding spicy and irritating foods.

• Quit smoking and alcohol. Foods and fruits rich in potassium can be consumed when sweating excessively. For those unable to eat, fluid therapy can be administered at a moderate speed to avoid increasing cardiac burden.

What should patients with chronic cor pulmonale pay attention to when using oxygen at home?

• Ensure oxygen safety by preventing fire, heat, shock, and oil. Keep flammable materials away and maintain a distance of at least 1 meter from heaters.

• Adjust the oxygen flow rate before wearing the oxygen tube to avoid sudden influx of large amounts of oxygen damaging the lungs.

• Monitor the effectiveness of oxygen therapy. If symptoms like dyspnea improve, it indicates the therapy is working; otherwise, seek medical attention.

• Ensure oxygen is warmed and humidified during therapy to prevent dry, cold oxygen from irritating and damaging airway mucosa.

• Avoid contamination and blockage of the oxygen tube to prevent cross-infection.

PREVENTION

How to Prevent Colds for Patients with Chronic Pulmonary Heart Disease?

• Exercise regularly to improve cardiopulmonary function;

• Avoid catching a cold and keep warm when going out in cold weather;

• Maintain clear airways; use nebulized inhalation for excessive phlegm, and suction if unable to expectorate;

• Adhere to daily home oxygen therapy to reduce hypoxia symptoms;

• Seek immediate respiratory care if fever, worsening cough, or increased phlegm occurs, and use antibiotics appropriately to avoid delays in treatment.

Why Should Patients with Chronic Pulmonary Heart Disease and Atrial Fibrillation Prevent Thrombosis?

Like other atrial fibrillation patients, atrial fibrillation causes turbulent blood flow in the atria, increasing the risk of thrombosis—similar to how slow or winding river water tends to stagnate. If a clot breaks loose, it can lead to life-threatening complications such as stroke, intestinal necrosis, or splenic infarction.

If there are no contraindications, it is best to take warfarin regularly to prevent thrombosis, maintaining an INR (International Normalized Ratio) between 2 and 3.