Reference — Respiratory
Pulmonary Hypertension & Cor Pulmonale Reference
When pressure in the pulmonary arteries stays high, the right ventricle must pump against it — and eventually fails. That right-heart failure from a lung cause is cor pulmonale. Find and treat the cause; support the failing right heart.
Educational use only. Diagnosis and pulmonary-vasodilator therapy are specialist- and provider-directed. This reference is an educational aid. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
What It Is
Pulmonary hypertension is sustained high pressure in the pulmonary arteries. The right ventricle, built for a low-pressure circuit, hypertrophies and then dilates and fails under the load. Cor pulmonale is right-ventricular enlargement/failure caused specifically by a lung or pulmonary-vascular disorder (not left-heart disease). Diagnosis is suggested by echocardiography and confirmed by right-heart catheterization.
Common Causes
| Category | Mechanism |
|---|---|
| Left heart disease | Heart failure / valve disease backs pressure up into the lungs (the most common cause) |
| Chronic lung disease | COPD, interstitial lung disease, and OSA cause chronic hypoxia → pulmonary vasoconstriction |
| Chronic thromboembolic (CTEPH) | Unresolved/recurrent pulmonary emboli obstruct the pulmonary vasculature |
| Pulmonary arterial hypertension (PAH) | Primary/idiopathic or associated (connective tissue disease, drugs) — the vessels themselves remodel |
Signs & Management
Signs: exertional dyspnea and fatigue first; then signs of right-heart failure — jugular venous distension, peripheral edema, hepatomegaly/ascites, a loud P2, and exertional chest pain or syncope. Management: treat the underlying cause (optimize left-heart failure, COPD, treat OSA with CPAP, anticoagulate CTEPH). For PAH, specialist pulmonary vasodilators are used (endothelin antagonists like bosentan, PDE-5 inhibitors like sildenafil, prostacyclins like epoprostenol). Supportive care includes oxygen for hypoxia, diuretics for fluid overload, and activity guidance.
NCLEX Pearls
- ✦Pulmonary hypertension strains the RIGHT ventricle → cor pulmonale = right-heart failure from a lung cause.
- ✦Common causes: left heart disease (#1), chronic lung disease (COPD/OSA), and chronic PE (CTEPH).
- ✦Signs are right-heart failure: JVD, peripheral edema, hepatomegaly/ascites, loud P2.
- ✦Chronic hypoxia drives pulmonary vasoconstriction — treat OSA (CPAP) and give oxygen.
- ✦PAH-specific therapy = pulmonary vasodilators (endothelin antagonists, PDE-5 inhibitors, prostacyclins).
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with American Association for Respiratory Care (AARC) · GOLD (COPD) / ATS / CHEST. It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →