The most common causes of chronic cor pulmonale

Chronic cor pulmonale is more common among the elderly, but in many cases it develops from middle age. The incidence of this disease is very high among smokers. The causes vary depending on the site of onset, and targeted treatment is required.

1. Bronchial and lung diseases

Chronic obstructive pulmonary disease (COPD) caused by chronic bronchitis and obstructive pulmonary emphysema is the most common, accounting for about 80% to 90%. It can be seen that COPD is the main cause of cor pulmonale in the elderly. The next most common diseases are bronchial asthma, bronchiectasis, severe pulmonary tuberculosis, pneumoconiosis, chronic diffuse pulmonary fibrosis (including idiopathic pulmonary fibrosis and secondary pulmonary fibrosis), lung radiotherapy, sarcoidosis, allergic alveolitis, eosinophilic granuloma, cryptogenic diffuse interstitial pneumonia, beryllium poisoning, progressive systemic sclerosis, disseminated lupus erythematosus, dermatomyositis, and alveolar lithiasis.

2. Thoracic movement disorders

Less common. Severe posterior spinal curvature, scoliosis, spinal tuberculosis, rheumatoid arthritis, extensive pleural adhesions and severe chest or spinal deformities caused by thoracoplasty, severe pleural hypertrophy, obesity with insufficient pulmonary ventilation, sleep breathing disorders and neuromuscular diseases such as poliomyelitis can cause limited chest movement, lung compression, bronchial twisting or deformation, leading to limited lung function, poor airway drainage, repeated lung infections, complications of emphysema, or fibrosis, hypoxia, pulmonary vasoconstriction and stenosis, increased resistance, pulmonary hypertension, and development of cor pulmonale.

3. Pulmonary vascular disease

Very rare. Allergic granulomatosis involving the pulmonary arteries, extensive or recurrent multiple pulmonary arteriolar embolism and pulmonary arteritis, and unexplained primary pulmonary hypertension can all cause stenosis and obstruction of the pulmonary arteries, leading to increased pulmonary artery vascular resistance, pulmonary hypertension, and right ventricular overload, and develop into cor pulmonale. It is occasionally seen in cases of compression of the pulmonary artery and pulmonary vein, such as mediastinal tumors, aneurysms, etc., and can also be seen in primary pulmonary hypertension.

4. Others

Pulmonary infection not only aggravates hypoxia and carbon dioxide retention, but also causes spasm of pulmonary arterioles, further increases pulmonary circulation resistance, and pulmonary artery pressure, thereby increasing the load on the right ventricle and even causing decompensation. Recurrent lung infections, hypoxemia and toxemia may cause myocardial damage and arrhythmias, and even heart failure; primary alveolar hypoventilation, congenital oropharyngeal malformations, sleep apnea syndrome, etc. can also lead to cor pulmonale; others can also be seen after lung resection and high altitude hypoxia. These diseases can cause hypoxemia, increase pulmonary vasoconstriction reactivity, lead to pulmonary hypertension, and develop into cor pulmonale.