The factors involved in the pathogenesis of Cor Pulmonale in Chronic Obstructive Pulmonary Disease (COPD) can be seen in the following diagram.
As seen in the pathogenesis of Cor Pulmonale diagram above, hypoxemia exerts an effect on the pulmonary vasculature separate from alveolar hypoxia, as does acidosis. The increased pulmonary vascular resistance is contibuted by the reduction in pulmonary capillary surface area caused by emphysema. Further more, an erythrocytosis may augment the pulmonary hypertension.
Cor pulmonale may lead to congestive heart failure (CHF), with worsening of respiration due to pulmonary edema, swelling of the legs due to peripheral edema and painful congestive hepatomegaly (enlargement of the liver due to tissue damage as explained in the Complications section. This situation requires diuretics (to decrease strain on the heart), sometimes nitrates (to improve blood flow), phosphodiesterase inhibitors such as sildenafil or tadalafil and occasionally inotropes (to improve heart contractility). CHF is a negative prognostic indicator in cor pulmonale.
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