Cor pulmonale

Question 1

what is cor pulmonale?

Answer 1

right heart failure due to chronic pulmonary hypertension

Question 2

what are the symptoms of cor pulmonale?

Answer 2

dyspnoea
fatigue
syncope

Question 3

state some signs of cor pulmonale?

Answer 3

1. ↑ JVP ̄c prominent a wave (atrial contraction)
2. Left parasternal heave
3. Loud P2±S3
4. Murmurs
   􏰀 PR: Graham Steell EDM
   􏰀 TR: PSM
5. Pulsatile hepatomegaly
6. Fluid: Ascites + Peripheral oedema

Question 4

what investigations should be done for cor pulmonale?

Answer 4

􏰀 Bloods: FBC, U+E, LFTs, ESR, ANA, RF

􏰀 ABG: hypoxia ± hypercapnoea

􏰀 CXR

􏰀 ECG: P pulmonale + RVH

􏰀 Echo: RVH, TR, ↑ PA pressure

􏰀 Spirometry

􏰀 Right heart catheterisation

Question 5

what does the CXR show for cor pulmonale ?

Answer 5

􏰁 Enlarged R atrium and ventricle

􏰁 Prominent pulmonary arteries

􏰁 Peripheral oligaemia

Question 6

what is p pulmonale ?

Answer 6

peaked P wave due to R atrial hypertrophy with pulmonary hypertension or tricuspid stenosis

Question 7

what is p mitrale?

Answer 7

broad bifid p wave due to L atrial hypertrophy with mitral stenosis

Question 8

what is the management of cor pulmonale ?

Answer 8

decreased pulmonary vascular resistance 
􏰁 LTOT
􏰁 CCB: e.g. nifedipine
􏰁 Sildenafil (PDE-5 inhibitor)
􏰁 Prostacycline analogues
􏰁 Bosentan (endothelin receptor antagonist)

ACEI and B blocker
diuretics

heart and lung transplant