The Patient With Cor Pulmonale

  • James E. Tobin


A 47-year-old man presented to the operating room from the ambulatory care unit for repair of bilateral inguinal hernias. The patient’s history was significant for a 30-year history of cigarette abuse with resultant severe chronic obstructive pulmonary disease (COPD), including increasing dyspnea, ankle edema, and ascites over the past year. He admitted to drinking about 1–2 pints of whiskey daily. His medications included theophylline, hydrocortisone, digoxin, furosemide, and isoetharine by inhalant. Vital signs were blood pressure 110/70mmHg, heart rate 125/min, respiratory rate 24/min, and temperature 37.0°C.


Chronie Obstructive Pulmonary Disease Pulmonary Hypertension Pulmonary Artery Pressure Pulmonary Vascular Resistance Functional Residual Capacity 
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  1. 1.
    Fishman A.P.: Chronic cor Pulmonale Am Rev Respir Dis 1975, 114: 775–94.Google Scholar
  2. 2.
    Nocturnal Oxygen Therapy Group: Continuous or nocturnal oxygen therapy in hypoxic COPD. Ann Intern Med 1980, 93: 391–8.PubMedGoogle Scholar
  3. 3.
    Inter-Society Commission for Heart Disease Resourccs: Primary prevention of pulmonary heart disease. Circulation 1970, 41: A17–A23.Google Scholar
  4. 4.
    McFadden E.R.: Cor pulmonale, in Braunwald E. (ed.): Heart Disease: A Textbook of Cardiovascular Medicine. Philadelphia: WB Saunders, 1988, pp l597–1616.Google Scholar
  5. 5.
    Hines R., Barash P.G.: Right ventricular failure, in Kaplan J. (ed.): Cardiac Anesthesia. New York: Grune & Stratton, 1987, pp 995–1020.Google Scholar
  6. 6.
    Mevrick B., Reid L.: Pulmonary hypertension—Anatomic and physiologic correlates. Clin Chest Med 1983, 4: 199–217.Google Scholar
  7. 7.
    Matthay R.A., Berger HJ.: Cardiovascular function in cor pulmonale. Clin Chest Med 1983, 4: 269–95.PubMedGoogle Scholar
  8. 8.
    Pirlo A.F., Benumof J.L., Trousdale F.R.: Atelectatic lobe blood flow: Open vs closed chest, positive pressure vs spontaneous ventilation. J Appl Physiol 1981, 50: 1022–6.PubMedGoogle Scholar
  9. 9.
    Santamore W.P., Lynch RR., Meier G., et al: Myocardial interaction between the ventricles. J Appl Physiol 1976, 41: 362–8.PubMedGoogle Scholar
  10. 10.
    Klein H.O., Tardima T., Ninio R., et al: The early recognition of right ventricular infarction: Diagnostic accuracy of the electrocardiographic V4R lead. Circulation 1983, 67: 558–65.PubMedCrossRefGoogle Scholar
  11. 11.
    Zilrak J.D. for the American College of Physicians: Preoperative pulmonary function testing. Ann Intern Med 1990, 112: 793–4.Google Scholar
  12. 12.
    Davies J.M., Latto I.O., Jones J.G.: Effects of stopping smoking for 48 hours on oxygen availability from the blood: A study on pregnant women. Br Med J 1979, 2: 355.PubMedCrossRefGoogle Scholar
  13. 13.
    Parker J.O., Kelkar K., West R.O.: Hemodynamic effects of aminophylline in cor pulmonale. Circulation 1966, 33: 17–25.PubMedGoogle Scholar
  14. 14.
    Matthay R.A., Berger HJ., Loke J., et al: Effect of aminophylline on right and left ventricular performance in COPD. Am J Med 1978, 65: 903–10.PubMedCrossRefGoogle Scholar
  15. 15.
    Weitzenblum E., Santegeau A., Ehrhart M., et al: Long-term oxygen therapy can reverse the progression of pulmonary hypertension in patients with COPD. Am Rev Respir Dis 1985, 131: 493–8.PubMedGoogle Scholar
  16. 16.
    Mathur P.N., Powles P., Pugsley S.O., et al: Effect of digoxin on right ventricular function in severe chronic airway obstruction. Ann Intern Med 1981, 95: 283–8.PubMedGoogle Scholar
  17. 17.
    Heinemann H.O.: Right-side heart failure and the use of diuretics. Am J Med 1978, 64: 367–70.PubMedCrossRefGoogle Scholar
  18. 18.
    Pear R.G., Rosenthal M.H.: Anesthetic management of patients with pulmonary hypertension, in Kirby R.L., Brown D.L., Thomas S.J. (eds.): Problems in Anesthesia. Philadelphia: JB Lippincott, 1987, pp 448–62.Google Scholar
  19. 19.
    Sorenson M.B., Jacobsen E.: Pulmonary hemodynamics during induction of anesthesia. Anesthesiology 1911, 46: 246–51.CrossRefGoogle Scholar
  20. 20.
    Hirshman CA., Edelstein G., Peetz S., et al: Mechanism of action of inhalation anesthesia on airways. Anesthesiology 1982, 56: 107–11.PubMedCrossRefGoogle Scholar
  21. 21.
    Stoelting R.K.: Inhaled anesthetics, in Pharmacology and Physiology in Anesthetic Practice, vol 2. Philadelphia: J.B. Lippincott, 1987, p 45.Google Scholar
  22. 22.
    Domino K.B., Broowec L., Alexander CM., et al: Influence of isoflurane on hypoxic pulmonary vasoconstriction in dogs. Anesthesiology 1986, 64: 423–9.PubMedCrossRefGoogle Scholar
  23. 23.
    Carlsson A.J., Bindsler L., Hedenstierna G.: Hypoxia-induced pulmonary vasoconstriction in the human lung. Anesthesiology 1987, 66: 312–6.PubMedCrossRefGoogle Scholar
  24. 24.
    Schulte-Sasse U., Hess W., Tarnow J.: Pulmonary vascular responses to nitrous oxide in patients with normal and high pulmonary vascular resistance. Anesthesiology 1982, 57: 9–13.PubMedCrossRefGoogle Scholar
  25. 25.
    Hilgenberg J.C, McCammon R.L., Stoelting R.K.: Pulmonary and systemic vascular responses to nitrous oxide in patients with mitral stenosis and pulmonary hypertension. Anesth Analg 1980, 59: 323–6.PubMedGoogle Scholar
  26. 26.
    Frost E.A.M., Tabaddor K., Arancibia C.U.: Hypotensive drugs and outcome in aneurysm surgery. Anesthesiology 1979, 51: S82.CrossRefGoogle Scholar
  27. 27.
    Jardin F., Farcot J.C, Boisante L., et al: Influence of PEEP on left ventricular performance. N Engl J Med 1981, 304: 387–92.PubMedCrossRefGoogle Scholar
  28. 28.
    Hines R.: Right ventricular function and failure. ASA Annual Refresher Courses, No. 521, 1988, San Fransisco.Google Scholar
  29. 29.
    Salmenpera M., Heinonen J.: Pulmonary vascular responses to moderate changes in PaCo2 after cardiopulmonary bypass. Anesthesiology 1986, 64: 311–5.PubMedCrossRefGoogle Scholar
  30. 30.
    Benumof J.L., Wahrenbrock E.A.: Dependency of hypoxic pulmonary vasoconstriction on temperature. J Appl Physiol 1977, 42: 56–8.PubMedGoogle Scholar
  31. 31.
    Ghignone M, Girling L., Prewitt R.M.: Volume expansion versus norepinephrine in treatment of a low cardiac output complicating an acute increase in right ventricular afterload in dogs. Anesthesiology 1984, 60: 132–5.PubMedCrossRefGoogle Scholar
  32. 32.
    Pearl R.G., Rosenthal M.H., Ashton J.P.A.: Pulmonary vasodilator effects of nitroglycerin and sodium nitroprusside in canine oleic acid-induced pulmonary hypertension. Anesthesiology 1983, 58: 514–8.PubMedCrossRefGoogle Scholar
  33. 33.
    Pearl R.G., Rosenthal M.H., Schroeder J.S., et al: Acute hemodynamic effects of nitroglycerin in pulmonary hypertension. Ann Intern Med 1983, 99: 9–13.PubMedGoogle Scholar
  34. 34.
    Packer M.: Vasodilator therapy for primary pulmonary hypertension. Ann Intern Med 1985, 103: 258–70.PubMedGoogle Scholar
  35. 35.
    D’Ambria M.N., La Raia P.J., Philbin D.M., et al: Prostaglandin E1—a new therapy for refractory right heart failure and pulmonary hypertension after mitral valve replacement. J Thorac Cardiovasc Surg 1985, 89: 567–72.Google Scholar

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© Birkhäuser Boston 1991

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  • James E. Tobin

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