cor pulmonale

see also:

• congestive cardiac failure
• the patient with swollen leg(s)

• cor pulmonale is right sided cardiac failure due primarily to a pulmonary aetiology
• accounts for ~7% of adult heart disease in western cultures and 10-30% of decompensated heart failure admissions

• in addition to the features of the primary pulmonary cause, the following may be found due to RVF:
  • right ventricular enlargement and failure
    • syncope on exertion in advanced disease
    • loud +/- palpable P2
    • fixed or paradoxic splitting of S2
    • pulmonary valve regurgitation (Graham Steel murmur) may be apparent
    • RV heave
    • ECG changes: right axis deviation, RVH, ST depression and T-wave inversions in the anterior leads
  • right atrial enlargement
    • ECG changes: abnormal P wave
    • atrial fibrillation
    • tricuspid valve incompetence
      • large V waves in JVP if severe incompetence
      • abnormal abdominal-jugular reflex
  • raised JVP
  • bilateral swollen legs
  • presacral oedema if bedridden
  • hepatic venous congestion ⇒ anorexia, RUQ discomfort, jaundice (icterus), pulsatile hepatomegaly, ascites

• chronic obstructive pulmonary disease (COPD) - accounts for half of all cases
• pulmonary embolism (PE) may cause acute cor pulmonale if massive and often fatal within 1st hour of PE
• Acute Respiratory Distress Syndrome (ARDS) is another potential cause of acute cor pulmonale
• pulmonary hypertension (PAH)
• pulmonary fibrosis
• polycythaemia rubra vera
• sickle cell disease (SCD)