Pulmonary hypertension and chronic cor pulmonale in COPD

Adil Shujaat, Ruth Minkin, Edward Eden

Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, St. Luke’s and Roosevelt Hospitals, Columbia University, New York, NY, USA

Abstract: Hypoxia and endothelial dysfunction play a central role in the development of pulmonary hypertension. Cor pulmonale is a maladaptive response to pulmonary hypertension. The presence of peripheral edema in cor pulmonale is almost invariably associated with hypercapnia. Correction of abnormalities of gas exchange and ventilation can ameliorate pulmonary hypertension and improve survival. This review focuses on new information about the pathogenesis and treatment of pulmonary hypertension in COPD including information derived from lung volume reduction surgery, the role of brain natriuretic peptide, exhaled nitric oxide for diagnosis, and the treatment of cor pulmonale with recently available specific pulmonary vasodilators.

Keywords: cor pulmonale, chronic obstructive pulmonary disease, pulmonary hypertension, brain natriuretic peptide, nitric oxide, phlebotomy