Cor pulmonale: Difference between revisions
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*Decreased retrosternal air space | *Decreased retrosternal air space | ||
===EKG=== | ===EKG=== | ||
*RVH | *[[RVH]] | ||
*Right axis deviation | *Right axis deviation | ||
* | *[[Right bundle branch block]] | ||
*R:S ratio > 1 in V1 | *R:S ratio > 1 in V1 | ||
*Large P wave in II, III, aVF | *Large P wave in II, III, aVF | ||
*Arrhythmia (PAC, SVT, MFAT, A-fib, A-flutter) | *Arrhythmia (PAC, SVT, MFAT, A-fib, A-flutter) | ||
===Echo=== | ===Echo=== | ||
*Increased RV thickness | *Increased RV thickness | ||
Revision as of 22:19, 9 September 2015
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, ILD
- Increased blood viscosity (sickle cell disease, polycythemia)
Chronic
Acute
- RV dilation
Signs and Symptoms
- Cough
- Dyspnea
- Tachypnea
- Hemoptysis
- Syncope
- Peripheral edema
- Cyanosis
Differential Diagnosis
Diagnosis
Blood tests
- CBC (polycythemia)
- ABG (oxygenation, acid-base status)
- alpha-1-antitrypsin
- ANA
- Coagulation studies (protein C/S, factor V Leiden etc)
CXR
- Enlarged pulmonary arteries
- Cardiomegaly
- Decreased retrosternal air space
EKG
- RVH
- Right axis deviation
- Right bundle branch block
- R:S ratio > 1 in V1
- Large P wave in II, III, aVF
- Arrhythmia (PAC, SVT, MFAT, A-fib, A-flutter)
Echo
- Increased RV thickness
- RV dilation
- Tricuspid insufficiency
- High estimated PA pressures
- Septal bowing into LV