PULMONARY HYPERTENSION AND COR PULMONALE

Question 1

Define cor pulmonale.

Answer 1

Cor pulmonale is defined as an alteration in the structure and function of the right ventricle caused by a primary disorder of the respiratory system that increases vascular resistance or raises blood pressure in the lungs.

Question 2

Chronic and acute episodes of pulmonary disease classically affect the heart in different ways. Can you remember how each affects the heart?

Answer 2

Chronic pulmonary disease will more often than not lead to hypertrophy of the right ventricle.
Acute pulmonary disease will more often than not lead to dilatation right ventricle.

Question 3

What are chronic causes of cor pulmonale? (Name at least 6)

Answer 3

COPD 
Primary pulmonary hypertension 
Uncontrolled persistent asthma 
Loss of lung tissue following trauma or surgery 
End-stage pneumoconiosis 
Sarcoidosis 
Untreated obstructive sleep apnea 
Interstitial lung disease
Sickle cell aneamia 
Severe thoracic kyphosis 
Polycythemia

Question 4

What are the acute causes of cor pulmonare? (Name 2)

Answer 4

Pulmonary embolism

Acute respiratory distress syndrome (ARDS)

Question 5

What may be seen on an ECG reading from someone with cor pulmonare?

Answer 5

Right axis deviation
Prominent R wave in V1
Inverted T wave in V1-V6
Large S wave in I, II, III
Large Q wave in III
Tall peaked P waves in II, III, aVF

Question 6

What is primary pulmonary hypertension?

Answer 6

Primary pulmonary hypertension (PPH) is a rare disease characterized by elevated pulmonary arterial blood pressure with no apparent cause (idiopathic).

Question 7

What is secondary pulmonary hypertension?

Answer 7

Secondary pulmonary hypertension is more common and is defined as elevated blood pressure in the pulmonary vasculature (arteries, veins or capillaries) as a direct result of a variety of conditions which either increase pulmonary blood flow or increase resistance to blood flow.

Question 8

What are the symptoms that someone with suspected cor pulmonale might present with? (Name 3)

Answer 8

The symptoms will often be associated to the underlying cause of the pulmonary hypertension.

Shortness of breath
Wheeze
Chronic wet cough

Question 9

What signs might someone with suspected cor pulmonare commonly present with? (Name 3)

Answer 9

Ascites
Pedal Oedema
Raised JVP
Hepatomegaly
Cyanosis
Tricuspid regurgitation
Wide split of heart sound S2