View source for Cor pulmonale

==Background==
*Remodeling of right ventricle in response to pulmonary pathology<ref>Aubry A, Paternot A, Vieillard-Baron A. [Cor pulmonale]. Rev Mal Respir. 2020 Mar;37(3):257-266. PMID 32088063</ref>
*Often caused by [[COPD]], [[pulmonary hypertension]], [[PE]], [[ARDS]]

==Clinical Features==
===Pathophysiology===
*Pulmonary vasoconstriction ([[hypoxia]], [[acidosis|acidemia]])
*Destruction of pulmonary vasculature by emphysema, [[interstitial lung disease]]
*Increased blood viscosity ([[sickle cell disease]], [[polycythemia]])
===Chronic===
*[[RVH]]
===Acute===
*RV dilation
===Signs and Symptoms===
*[[Cough]]
*[[Dyspnea]]
*[[Tachypnea]]
*[[Hemoptysis]]
*[[Syncope]]
*Peripheral edema
*Cyanosis

==Differential Diagnosis==
*Cardiovascular
**[[ACS]]
**[[Acute Valve Dysfunction]]
**[[Aortic Dissection]]
**[[Dysrhythmia]]
**[[Endocarditis]]
**[[Hypertensive Emergency]]
**[[Pericardial Tamponade]]
*Pulmonary
**[[COPD]]
**[[PE]]
**[[pneumonia]]
*Other
**Pure [[fluid overload|volume overload]]
***[[Renal Failure]]
***Post-[[Transfusion]]
**[[Sepsis]]

==Evaluation==
===Blood tests===
*CBC ([[polycythemia]])
*[[ABG]] (oxygenation, acid-base status)
*α-1-antitrypsin
*ANA
*Coagulation studies (protein C/S, factor V Leiden etc)
===[[CXR]]===
*Enlarged pulmonary arteries
*Cardiomegaly
*Decreased retrosternal air space
===[[ECG]]===
*[[RVH]]
*Right axis deviation
*[[Right bundle branch block]]
*R:S ratio > 1 in V1
*TWI in V1-3 in acute right heart strain (as opposed to upright t-waves in posterior MI)
*S1 Q3 T3 in acute right heart strain
*Large P wave in II, III, aVF
*[[Arrhythmia]] ([[PAC]], [[SVT]], MFAT, [[A-fib]], A-[[flutter]])

===[[Echocardiography]]===
*Increased RV thickness
*RV dilation
*Tricuspid insufficiency
*High estimated PA pressures
*Septal bowing into LV
===CTPA for PE===
===V/Q scan for PE===

==Management==
*Treat underlying disease
*Fluids, [[vasopressors|vasoconstrictors]] to support BP in acute setting
*[[Oxygen therapy]]: decreases pulmonary vasoconstriction
*[[Diuretics]]: decrease RV filling volume
*[[Calcium channel blockers]]: vasodilate the pulmonary arteries
*Beta agonists ([[epoprostenol]], iloprost): bronchodilate
*Phlebotomy for severe hypoxia leading to polycythemia
*Lung transplant or heart-lung transplant as last resort

==Disposition==


==See Also==
*[[Pulmonary Embolism]]
*[[COPD]]

==External Links==

==References==
<references/>

[[Category:Pulmonary]][[Category:Cardiology]]