Cor pulmonale: Difference between revisions
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==Background== | ==Background== | ||
*Remodeling of right ventricle in response to pulmonary pathology | *Remodeling of right ventricle in response to pulmonary pathology | ||
*Often caused by COPD, pulmonary hypertension, PE, ARDS | *Often caused by [[COPD]], [[pulmonary hypertension]], [[PE]], [[ARDS]] | ||
==Clinical Features== | ==Clinical Features== | ||
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*Pulmonary vasoconstriction (hypoxia, acidemia) | *Pulmonary vasoconstriction (hypoxia, acidemia) | ||
*Destruction of pulmonary vasculature by emphysema, ILD | *Destruction of pulmonary vasculature by emphysema, ILD | ||
*Increased blood viscosity (sickle cell, polycythemia) | *Increased blood viscosity ([[sickle cell disease]], polycythemia) | ||
===Chronic=== | ===Chronic=== | ||
*RVH | *[[RVH]] | ||
===Acute=== | ===Acute=== | ||
*RV dilation | *RV dilation | ||
===Signs and Symptoms=== | ===Signs and Symptoms=== | ||
*Cough | *[[Cough]] | ||
*Dyspnea | *[[Dyspnea]] | ||
*Tachypnea | *[[Tachypnea]] | ||
*Hemoptysis | *[[Hemoptysis]] | ||
*Syncope | *[[Syncope]] | ||
*Peripheral edema | *Peripheral edema | ||
*Cyanosis | *Cyanosis | ||
Revision as of 22:10, 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
- RBBB
- 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