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Respiratory failure

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Respiratory Failure

inadequate blood oxygenation or CO2 removal

A syndrome rather than a diseaseHypoxemic

PaO2 < 60 mmHg1.Acute2.Chronic

Hypercapnic

PaCO2 > 45 mmHg

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Type 3

post anaesthesia

Type 4

sepsis , cardiac failure

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Treatment

Type 1 Oxygenation,nasal mask, intubation

Type 2 Endotracheal intubation amust

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Primary Right Heart Failure

(Cor Pulmonale)

http://www.bartleby.com/107/138.html

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http://www.bartleby.com/107/138.html

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Cor Pulmonale Alteration of the right ventricular

structure or function that is due to

pulmonary hypertension caused bydiseases affecting the lung or itsvasculature.

Excludes Left sided heart disease with 2nd

changes

Congenital heart disease

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Etiologies Emphysema

Pulmonary emboli

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Symptoms of Cor pulmonale

Directly attributable to PHTn Dyspnea on exertion, fatigue, lethargy

Chest pain, syncope with exertion

Less common Cough, hemoptysis, hoarseness

With severe right ventricular (RV) failure Passive hepatic congestion

Anorexia, right upper quadrant discomfort

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Physical FindingsCardiac findings

Prominent a wave in the jugular venous pulse. withS4

Elevated jugular venous pressure with aprominent vwave

RV S3 High pitched tricuspid regurgitant murmur

Extra cardiac changes

Hepatomegaly, pulsatile liver

Peripheral edema-often related to hypercarbiaand passive Na+ and water retention

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Other Areas of Fluid

Retention Pleural effusion, often bilateral

Right heart failure until proved

otherwise Engorged inferior vena cava

Hepatic congestion

Ascites Anasarca

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Evaluation Laboratory CBC, BNP Chest radiograph Electrocardiogram Doppler echocardiography Pulmonary function tests

Lung biopsy

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Normal Chest Radiograph

Normal chest film

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Radiograph in Cor Pulmonale

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Normal

Electrocardiogram

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ECG in Cor Pulmonale

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Treatment

Oxygen Relieves pulmonary vasoconstriction

Decreases PVR

Increases RV Stroke volume and cardiac output

Renal vasoconstriction may be relieved withincrease in urinary sodium excretion

Improves arterial oxygen tension with

enhanced delivery to Heart

Brain

Other vital organs (kidneys)

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Treatment

OxygenDiureticsACEI, ARB s , Spironolactone

Nitric oxideIpoprostenolSildenafil

phlebotomy

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Summary

Cor Pulmonale Is an end stage manifestation of primary

right sided heart failure. For the most part, treatment is supportive.

In COPD, oxygen is a mainstay of therapy. Diuretics, ACEI, ARB, beta blockers may add

efficacy. Better drug therapy, directed at pulmonary

artery relaxation, may be on the horizon. Whatever the etiology the prognosis remains

poor