cor pulmonale

Question 1

define-

Answer 1

abnormal enlargement of the right side of the heart as a result of disease of the lungs or the pulmonary blood vessels.

Question 2

classification

Answer 2

• acute - right ventricular dilatation following massive pulmonary embolism.
• chronic - right ventricular hypertrophy secondary to prolonged pressure overload - whether related to narrowings or obstructions of major arteries or compression of septal capillaries.

Question 3

causes

Answer 3

RHF due to chronic PHTN

• pulmonary arterial htn
• pulmonary venous htn

Question 4

s/s

Answer 4

Symptoms include:

• dysnpnoea
• fatigue
• syncope

Signs include:

• warm, cyanosed extremities
• bounding pulse
• raised JVP
• may be functional tricuspid incompetence - systolic ‘v’ waves seen in JVP
• Murmurs  PR: Graham Steell EDM ;;  TR: PSM
• gallup rhythm, loud P2 due to pulmonary hypertension, but overlying emphysema may reduce heart sounds
• pulsatile hepatomegaly, peripheral oedema, ascites

Question 5

ix

Answer 5

1. CXR: prominent pulmonary artery and right heart (atrium and ventricle)
2. ECG: p pulmonale, right axis deviation, right ventricular hypertrophy with ‘strain pattern’ (inverted T waves in V1-4)
3. FBC: polycythaemia
4. Echo: RVH, TR, ↑ PA pressure
5. ABG: hypoxia ± hypercapnoea

Question 6

mx

Answer 6

Rx underlying condition

↓ pulmonary vascular resistance

 LTOT

 CCB: e.g. nifedipine

 Sildenafil (PDE-5 inhibitor)

 Prostacycline analogues

 Bosentan (endothelin receptor antagonist)

Cardiac failure

 ACEi + β-B (caution if asthma)

 Diuretics

Heart-Lung Tx

nb…

• use a loop diuretic for oedema, consider long-term oxygen therapy
• ACE-inhibitors, calcium channel blockers and alpha blockers are not recommended by NICE

Question 7

Prognosis

Answer 7

 50% 5ys