COPD - Cor Pulmonale

Question 1

What is Cor Pulmonale?

Answer 1

Right Sided Heart Failure due to Respiratory Disease.

Question 2

Aetiology of Cor Pulmonale (5).

Answer 2

1. COPD (Commonest).
2. PE.
3. ILD.
4. CF.
5. Primary Pulmonary HTN.

Question 3

Pathophysiology of Cor Pulmonale.

Answer 3

1. Increased Pressure and Resistance in Pulmonary Arteries - Pulmonary Hypertension.
2. RV is unable to effectively pump blood out of the ventricle and into the pulmonary arteries.
3. Back pressure of blood into the RA, Vena Cava and the systemic venous system.

Question 4

What can lead to Pulmonary Hypertension in Cor Pulmonale?

Answer 4

1. Emphysema - Loss of Pulmonary Arterioles + Capillaries.
2. Chronic Hypoxia - Pulmonary Arterial Vasoconstriction.
3. Chronic Hypoxia - Increased EPO Secretion - Polycythaemia - Increased Viscosity.

Question 5

Clinical Presentation of Cor Pulmonale.

Answer 5

1. Asymptomatic - Early.
2. SOB (also by cause).
3. Peripheral Oedema.
4. Syncope + Chest Pain.

Question 6

Examination Findings of Cor Pulmonale.

Answer 6

1. Hypoxia and Cyanosis.
2. Raised JVP.
3. Peripheral Oedema.
4. S3 Sound.
5. Murmur - Pan-Systolic in Tricuspid Regurgitation.
6. Hepatomegaly (Pulsatile in Tricuspid Regurgitation).

Question 7

ECG Changes in Cor Pulmonale.

Answer 7

1. P-Pulmonale - Increased Amplitude of P Wave (Right Atrial Hypertrophy).
2. RBBB and RAD - (Right Ventricular Hypertrophy).

Question 8

Management of Cor Pulmonale.

Answer 8

1. Treat symptoms and underlying cause.

2. LTOT.