The most common cause of chronic cor pulmonale, they are actually the culprits

There are many causes of chronic cor pulmonale, the most common ones are chronic obstructive pulmonary disease, hypoxia, restrictive lung disease, etc. In addition, cor pulmonale can be regarded as an adaptive response of the pulmonary arterioles and right ventricle to the increased pulmonary circulation resistance and pressure caused by chronic lung disease. It is a special heart disease.

① In chronic obstructive pulmonary disease, obstruction of small airways leads to ventilation disorders, and lung infection, pulmonary interstitial fibrosis and emphysema can all destroy the blood-gas barrier structure of the lungs, reduce the gas exchange area, and lead to ventilation dysfunction. It reduces the oxygen partial pressure in the alveolar gas (hypoxia) and increases the carbon dioxide partial pressure, causing pulmonary arteriolar spasm (hypoxia can interfere with the potassium and sodium ion exchange in the vascular smooth muscle cell membrane and promote mast cells to release vasoactive substances, causing pulmonary arteriolar spasm).

② Hypoxia can also lead to changes in the pulmonary vascular configuration, causing thickening of the tunica media of pulmonary arterioles and muscularization of non-muscular arterioles, thereby leading to increased pulmonary circulation resistance and pulmonary hypertension.

③ Restrictive lung diseases, such as chest wall lesions, spinal curvature, pleural fibrosis and post-thoracoplasty, can not only cause restrictive ventilation disorders, but also compress larger pulmonary blood vessels and cause pulmonary vascular distortion, leading to increased pulmonary circulation resistance and pulmonary hypertension.

④ Pulmonary vascular diseases, such as recurrent pulmonary embolism and primary pulmonary vascular disease, can also reduce the area of ​​the pulmonary vascular bed and lead to increased pulmonary circulation resistance and pulmonary hypertension. In response to the increased pulmonary circulation resistance, the smooth muscle muscularization of the pulmonary arterioles occurs, and the right ventricle also undergoes adaptive hypertrophy of the myocardial cells. However, the adaptive capacity of the right ventricular myocardial cells is limited. When the right ventricular load increases by 2 to 3.5 times, cardiac cavity dilatation is very likely to occur. Therefore, cor pulmonale can be regarded as an adaptive response of the pulmonary arterioles and right ventricle to the increased pulmonary circulation resistance and pressure caused by chronic lung disease, and is a special heart disease.