Cor pulmonale

Question 1

What is it

Answer 1

RHF due to chronic pulmonary arterial HTN

Question 2

What are the causes?

Answer 2

1. Lung disease: asthma, COPD, PF, bronchiectasis, lung resection
2. Pulmonary vascular disease: PE(acute), ARDS
3. Thoracic cage abnormality: kyphoscoliosis
4. Neuromuscular disease: myasthenia gravis, mnd

Question 3

What are the sx?

Answer 3

SOB, fatigue, syncope

Question 4

What are the signs?

Answer 4

Cyanosis
Tachycardia
raised JVP
RV heave 
Loud P2
Pansystolic murmur 
Early diastolic Graham Steel murmur 
Hepatomegaly and oedema

Question 5

What are the investigations and what would they show

Answer 5

1. ABG - hypoxia +/- hypercapnia
2. CXR - enlarged RA + RV, prominent pulmonary arteries
3. ECG - P pulmonale (sharp peaked P wave), right axis deviation, RV hypertrophy

Question 6

What is the management ?

Answer 6

1. manage underlying cause
2. Rx res failure: acutely - 24% O2 if PaO2 <8, gradually increase O2 if PCO2 stable
   Long term O2
3. Rx HF
4. If young - heart lung transplant