Cor pulmonale describes heart disease secondary to lung diseases (pulmonary heart disease). These conditions cause severe chronic hypoxemia, which increases pulmona artery pressures and right ventricular workload resulting in right heart failure. Hypoxemia is a potent stimulus for vasoconstriction and pulmonary hypertension. Right heart failure is manifested by shortness of breath and easy fatigability at rest or mild activity. Heart failure causes retention of salt and water by the kidneys which leads to swelling of the legs; the legs are brine-logged and not simply waterlogged.
A. Causes
1. Chronic Bronchitis and Emphysema
The most common causes of cor pulmonale are long-severe chronic bronchitis and emphysema.
2. Chronic and Restrictive Lung Diseases
Chronic obstructive lung disease (COPD) is the most common cause of cor pulmonale. Long-standing severe chronic bronchitis and emphysema are the main causes of chronic obstructive lung disease, which leads to severe hypoxemia.
Restrictive lung diseases also are a common cause of cor pulmonale. They encompass a large group of diffuse lung diseases that show a typical filling of the alveoli and/or infiltration of the pulmonary interstitium, which results in a characteristic pattern of restrictive lung impairment with reduction in lung volumes and decrease in the compliance of the lung (see chapter entitled Pulmonary Arterial Hypertension).

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