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Cor pulmonale: Right-sided heart failure

Cor pulmonale is a condition that causes right-sided heart failure. Long-term high blood pressure in the arteries of the lungs and the right ventricle of the heart usually leads to cor pulmonale. But some other causes also lead to this heart condition. Shortness of breath, cyanosis, chest pain and wheezing are some of the symptoms of the heart disease. Various diagnostic tests are necessary to diagnose and determine the cause of cor pulmonale. The treatment of cor pulmonale focuses on treating the underlying cause. The prognosis of patients with cor pulmonale is variable.

  • Causes: Pulmonary hypertension and low oxygen levels in blood
  • Symptoms
  • Diagnosis and examinations
  • Treatment cor pulmonale
  • Guidelines for cor pulmonale
  • Prognosis is variable
  • Complications of right-sided heart failure


Causes: Pulmonary hypertension and low oxygen levels in blood

Pulmonary hypertension

High blood pressure in the blood vessels of the lungs is known as pulmonary hypertension. This is the most common cause of cor pulmonale. In patients with pulmonary hypertension, changes in the small blood vessels in the lungs lead to increased blood pressure in the right side of the heart. This makes it harder for the heart to pump blood to the lungs. If this increased pressure remains, pressure will be placed on the right side of the heart. This pressure causes cor pulmonale.

Low oxygen levels in the blood

Lung diseases that result in low oxygen levels in the blood for a long time also cause cor pulmonale. This concerns the following lung disorders:

  • autoimmune conditions that damage the lungs, such as scleroderma
  • chronic obstructive pulmonary disease (COPD)
  • chronic blood clots in the lungs
  • idiopathic (no specific cause) narrowing of the blood vessels (vasoconstriction) of the lungs
  • interstitial lung disease (scarring and inflammation in the lungs)
  • kyphoscoliosis (backward and sideways curvature of the spine)
  • cystic fibrosis (cystic fibrosis with blockage of organs)
  • obstructive sleep apnea syndrome which causes the patient to stop breathing due to inflammation of the airways

 Chest pain is one of the symptoms of cor pulmonale / Source: Pexels, Pixabay


Shortness of breath or dizziness on exertion are often the first symptoms of cor pulmonale. In addition, a rapid heart rate (tachycardia) occurs and the patient suffers from palpitations. Over time, symptoms occur with smaller efforts and even at rest. Other possible symptoms then include:

  • bluish lips and fingers (cyanosis)
  • extreme fatigue
  • fainting during exertion
  • swollen feet or ankles
  • chest pain, usually in the front of the chest
  • symptoms of lung disease, such as wheezing (stridor) or coughing
  • weakness

 A fluid accumulation in the abdomen may indicate right-sided heart failure / Source: James Heilman, MD, Wikimedia Commons (CC BY-SA-3.0)

Diagnosis and examinations

Physical examination

The doctor performs a physical examination and questions the patient about his symptoms. During the physical examination, the doctor discovers the following:

  • a fluid accumulation in your abdomen (ascites)
  • abnormal heart sounds
  • bluish skin (cyanosis)
  • a liver swelling (hepatomegaly)
  • swollen neck veins, which is a sign of high pressure in the right side of the heart
  • swollen ankles

 Electrocardiography (ECG) / Source: CardioNetworks, Wikimedia Commons (CC BY-SA-3.0)Diagnostic examination The following examinations help in the diagnosis of cor pulmonale:

  • a blood test
  • a CT scan of the chest
  • an echocardiography (examination of the heart using sound waves)
  • an electrocardiography (measurement of the electrical activity of the heart)
  • a lung biopsy (rare) (examination of tissue from the lungs)
  • a pulse oximetry (measurement of the oxygen level in the blood)
  • a right heart catheterization
  • an x-ray of the chest (chest x-ray)
  • a spirometry (test to measure lung function)
  • a ventilation and perfusion scan of the lungs (V/Q scan)


Treatment cor pulmonale

The doctor treats the medical problems that cause pulmonary hypertension, as they may lead to cor pulmonale. The doctor first examines the cause of the condition and then chooses the best possible treatment(s) for the patient. The patient receives medication through a vein (intravenously), takes it through the mouth (orally), or inhales it. The doctor monitors him closely to see whether the medication is effective and also monitors for any side effects.Other treatments include:

  • Blood thinners to reduce the risk of blood clots
  • Medicines to relieve the symptoms of heart failure (poor pumping of blood by the heart).
  • Oxygen therapy at home
  • A lung or heart-lung transplant, if the medication does not work


Guidelines for cor pulmonale

The patient follows some important guidelines.

  • He uses oxygen if the doctor prescribes it.
  • He receives an annual flu vaccine, as well as other vaccines
  • He quits smoking
  • He avoids traveling to high altitudes.
  • He avoids strenuous activities and heavy lifting.
  • Women are not allowed to get pregnant.


Prognosis is variable

The cause of cor pulmonale largely determines the outlook. Stopping smoking also gives a more favorable prognosis than if the patient continues to smoke. The five-year survival rate for cor pulmonale due to COPD is approximately 50%. Adjustments outside the home are often necessary when the disease worsens.

Complications of right-sided heart failure

Possible complications of cor pulmonale include:

  • Death
  • A serious fluid retention in the body
  • A shock
  • Life-threatening shortness of breath


read more

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  • Heart Health: Tips for a Healthy Heart & Heart Disease Prevention