Cor pulmonale

Background

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

Differential Diagnosis

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
  • S1 Q3 T3 in acute right heart strain
  • 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

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

Disposition

See Also

External Links

References