Cor Pulmonale

Question 1

What is cor pulmonale?

Answer 1

Right heart failure caused by respiratory disease

Question 2

What is the pathophysiology of cor pulmonale?

Answer 2

Increased pressure and resistance in pulmonary arteries (pulmonary hypertension)

Results in the right ventricle being unable to effectively pump blood out of the ventricle and into the pulmonary arteries.

It is pumping against high resistance

This leads to back pressure of blood in the right atrium, the vena cava and the systemic venous system.

Question 3

Respiratory causes of cor pulmonale

Answer 3

COPD is the most common cause

Pulmonary Embolism

Interstitial Lung Disease

Cystic Fibrosis

Primary Pulmonary Hypertension

Question 4

Presentation of cor pulmonale

Answer 4

SOB - main complaint
- Worse on exertion

Peripheral oedema
Syncope
Chest pain

Question 5

Signs of cor pulmonale on examination

Answer 5

Hypoxia
Cyanosis

Raised JVP
Peripheral oedema

Third heart sound
Murmurs e.g. pan-systolic in tricuspid regurgitation

Hepatomegaly - due to back pressure in the hepatic vein (pulsatile in tricuspid regurgitation)

Question 6

Management of cor pulmonale

Answer 6

Treat the symptoms and underlying cause

LTOT often used

The prognosis is poor unless there is a reversible underlying cause.