Cor pulmonale: Difference between revisions
(Created page with "==Background== ==Clinical Features== ==Differential Diagnosis== ==Diagnosis== ==Management== ==Disposition== ==See Also== ==External Links== ==References== <re...") |
(→ECG) |
||
| (32 intermediate revisions by 7 users not shown) | |||
| Line 1: | Line 1: | ||
==Background== | ==Background== | ||
*Remodeling of right ventricle in response to pulmonary pathology | |||
*Often caused by [[COPD]], [[pulmonary hypertension]], [[PE]], [[ARDS]] | |||
==Clinical Features== | ==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== | ==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== | ==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== | ==Disposition== | ||
| Line 18: | Line 84: | ||
==See Also== | ==See Also== | ||
*[[Pulmonary Embolism]] | |||
*[[COPD]] | |||
==External Links== | ==External Links== | ||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category: | [[Category:Pulmonary]][[Category:Cardiology]] | ||
Latest revision as of 00:51, 28 September 2023
Background
- Remodeling of right ventricle in response to pulmonary pathology
- Often caused by COPD, pulmonary hypertension, PE, ARDS
Clinical Features
Pathophysiology
- Pulmonary vasoconstriction (hypoxia, acidemia)
- Destruction of pulmonary vasculature by emphysema, interstitial lung disease
- Increased blood viscosity (sickle cell disease, polycythemia)
Chronic
Acute
- RV dilation
Signs and Symptoms
- Cough
- Dyspnea
- Tachypnea
- Hemoptysis
- Syncope
- Peripheral edema
- Cyanosis
Differential Diagnosis
- Cardiovascular
- Pulmonary
- Other
- Pure volume overload
- Renal Failure
- Post-Transfusion
- Sepsis
- Pure volume overload
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, 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