Lung

Cor Pulmonale

search

Cor Pulmonale

  • Pathophysiology
  1. Right Ventricular Enlargement from primary lung disease
  2. Results in Right Ventricular Hypertrophy
  3. Eventually leads to Right Ventricular Failure
  • Causes
  1. See Respiratory Causes of Pulmonary Hypertension
  • Symptoms
  1. Retrosternal Chest Pain
  2. Cough
  3. Dyspnea
  4. Fatigue
  5. Sputum production
  • Signs
  1. Tachycardia
  2. Cyanosis
  3. Finger Clubbing
  4. Accentuated right ventricle precordial thrust
    1. Along left sternal border
  5. Accentuated and Split pulmonic heart sound (P2)
  6. Right sided S4 Heart Sound
  7. Right Sided Heart Failure signs
    1. Kussmaul's Sign
      1. Distention of jugular neck veins on inspiration
    2. Pulsus Paradoxus
      1. Exaggerated fall in Blood Pressure on inspiration
    3. Jugular Vein Distention
    4. Hepatomegaly with Ascites
    5. Pedal edema
  • Differential Diagnosis (Non-pulmonary disease)
  1. Mitral Stenosis
  2. Left to right cardiac shunts
  • Labs
  1. Complete Blood Count
    1. Erythrocytosis
  2. Electrocardiogram
    1. Right Ventricular Hypertrophy
  3. Pulmonary Function Tests
  4. Arterial Blood Gas
  • Radiology
  1. Chest XRay
    1. Enlarged pulmonary artery
    2. Dilated right ventricle
    3. Primary Pulmonary Hypertension signs
      1. Tapering of pulmonary artery branches
  2. Echocardiogram
    1. Right Ventricular Hypertrophy
  3. VQ Scan (Radionuclide Lung Scan)
    1. Evaluate suspected recurrent Pulmonary Embolism
  • Management
  1. Pulmonary therapies
    1. Bronchodilators
    2. Oxygen
    3. Antibiotics when indicated
  2. Right Ventricular Failure
    1. Low Sodium Diet
    2. Diuretics
    3. Digoxin (Use with caution)
    4. Chronic Anticoagulation on Coumadin
  3. Arrhythmias: Treat Supraventricular Tachyarrhythmias
    1. Digoxin
    2. Quinidine
    3. Verapamil
    4. Avoid Beta-Blockers
  • References
  1. Palevsky (1990) JAMA 263:2347-53 [PubMed]