FN: Cor Pulmonale

Question 1

Definition

Answer 1

RHF due to chronic PHT

Question 2

Symptoms

Answer 2

• Dyspnoea
• Fatigue
• Syncope

Question 3

Signs

Answer 3

1. ↑ JVP ̄c prominent a wave 2. Left parasternal heave
2. LoudP2±S3 4. Murmurs
   􏰀 PR: Graham Steell EDM
   􏰀 TR: PSM
3. Pulsatile hepatomegaly
4. Fluid: Ascites + Peripheral oedema

Question 4

Investigations bloods

Answer 4

FBC
U&E
LFTs
ESR
ANA
RF

Question 5

ABG shows

Answer 5

Hypoxia ± hypercapnia

Question 6

CXR

Answer 6

􏰁 Enlarged R atrium and ventricle 􏰁 Prominent pulmonary arteries
􏰁 Peripheral oligaemia

Question 7

ECG

Answer 7

P Pulmonale + RVH

Question 8

Echo

Answer 8

RVH
TR
Increase PA pressure

Question 9

Special investigations

Answer 9

Spirometry

Right heart catherisation

Question 10

Management

Answer 10

Treat underlying condition
Reduced pulmonary vascular resistance
Cardiac failure
Heart-lung treatment

Question 11

Reducing vascular resistance

Answer 11

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

Question 12

Cardiac failure

Answer 12

􏰁 ACEi + β-B (caution if asthma) 􏰁 Diuretics

Question 13

Prognosis

Answer 13

50% at 5 yrs