Cor Pulmonale
Given a patient presentation, identify the pertinent positives on the physical exam associated with cor pulmonale:
Increase in chest diameter Labored breathing with retrations of the chest wall Jugular venous distention Cyanosis Auscultation of the lungs: wheezes and crackles
Explain the pathogenesis of cor pulmonale:
Lung disorders make it harder to oxygenate the blood, which can lead to hypoxia, or low oxygen levels. In response, this triggers a process called hypoxic pulmonary vasoconstriction. When lots of alveoli are poorly ventilated like with a lung disorder, they all start to vasoconstrict and the mechanism backfires. When lots of arterioles vasoconstrict together, there's an increase in resistance and it leads to pulmonary hypertension - with the pulmonary blood pressure rising above 25 mm Hg. The high pulmonary pressure makes it hard for the right ventricle to pump blood into the pulmonary circulation
Cor pulmonale chest exam:
-left parasternal or subxiphoid heave Heptojugular reflux ascites
Cor pulmonale heart exam:
-splitting of the second heart sound with accentuation of the pulmonic component -Systolic ejection murmur with a sharp ejection click over the region of the pulmonary artery
What is cor pulmonale?
Cor pulmonale is when a lung disorder causes right-sided heart dysfunction that can develop into right-sided heart failure.
Define cor pulmonale:
Cor pulmonale refers to PH-induced altered structure (eg, hypertrophy or dilatation) and/or impaired function of the right ventricle (RV) that is associated with chronic lung disease and/or hypoxemia
Explain the role of 2-D echocardiography in diagnosis of cor pulmonale:
Right ventricular enlargement leads to an increase of the transverse diameter of the heart shadow to the right on the posteroanterior view and filling of the retrosternal air space on the lateral view.
Cor pulmonale lung percussion:
hyperresonance - a sign of the COPD
Explain the role of right heart catheterization in diagnosis of cor pulmonale:
most precise method for diagnosis and quantification of pulmonary hypertension. Indicated when echocardiography cannot assess the severity of disease
Identify medications that can be used in the treatment of cor pulmonale:
o Diuretics o Calcium channel blockers—diltiazem and sustained release nifedipine can lower pulmonary pressures o Theophylline - reduces pulmonary vascular resistance and weak inotropic effect o Anticoagulants for thromboembolic disease
Given a patient presentation, identify the symptoms consistent with cor pulmonale:
o Fatigue o Tachypnea o Exertional dyspnea o Cough o Angina pain due to right ventricular ischemia or pulmonary artery stretching -hepatomegaly
List common causes of cor pulmonale:
o something that damages the lung tissue, like chronic obstructive pulmonary disease, o something that damages the pulmonary vessels themselves, like chronic thromboembolisms or recurrent blood clots, o something that affects the spine or ribcage, like kyphoscoliosis, where the spine is curved and the lungs can't fully expand
The main causes of cor pulmonale stem from:
pulmonary hypertension
What is the gold standard test to dx cor pulmonale?
to directly measure pulmonary pressures and assess for response to vasodilating medications is a right heart catheterization
