Cor pulmonale in COPD is primarily due to which pathophysiology?

• A. Right-sided heart failure due to pulmonary hypertension
• B. Left-sided heart failure due to LV dysfunction
• C. Systemic hypertension
• D. Pulmonary embolism

Answer: (A)

The key idea is that cor pulmonale in COPD arises from elevated pressures in the pulmonary circulation caused by chronic lung disease. Long-standing hypoxemia in COPD triggers hypoxic pulmonary vasoconstriction, which raises pulmonary vascular resistance and pulmonary artery pressures. This higher afterload on the right ventricle leads to right ventricular hypertrophy and, over time, right-sided heart failure. So the primary pathophysiology is right-sided heart failure due to pulmonary hypertension stemming from COPD-related hypoxemia and pulmonary vasoconstriction. Left-sided heart failure would involve LV dysfunction and pulmonary edema, systemic hypertension isn’t the direct driver of this process, and while pulmonary embolism can cause acute right heart strain, it doesn’t explain the chronic mechanism seen with COPD.