Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 10-54: Pulmonary Heart Disease (Cor Pulmonale) + Key Features Download Section PDF Listen +++ ++ Right ventricular (RV) systolic and diastolic failure from lung disease or pulmonary vascular disease Most common causes: pulmonary hypertension, chronic obstructive pulmonary disease (COPD), or idiopathic pulmonary fibrosis Less common causes Pneumoconiosis Kyphoscoliosis + Clinical Findings Download Section PDF Listen +++ ++ Predominant symptoms—intensified with RV failure—are related to the underlying pulmonary disorder Chronic productive cough Exertional dyspnea Wheezing Easy fatigability Weakness Other possible findings Dependent edema Right upper quadrant pain (hepatic congestion) Cyanosis Clubbing Distended neck veins RV heave Gallop Ascites Severe lung disease can be a cause of low cardiac output by reducing LV filling and subsequently LV preload and stroke volume Polycythemia is often present Arterial oxygen saturation often < 85% + Diagnosis Download Section PDF Listen +++ ++ Symptoms and signs of COPD with elevated jugular venous pressure, parasternal lift, edema, hepatomegaly, ascites ECG Tall, peaked P waves (P pulmonale), right axis deviation, and RV hypertrophy Q waves in leads II, III, and aVF may mimic myocardial infarction Frequent, nonspecific supraventricular arrhythmias Chest radiograph Enlarged RV and pulmonary artery Possible signs of pulmonary parenchymal disease Pulmonary function tests to confirm underlying lung disease Echocardiogram should demonstrate normal LV size and function but with RV and right atrial dilation and RV dysfunction Multi-slice CT scan to exclude pulmonary emboli Serum B-type natriuretic peptide (BNP) level may be elevated from RV dysfunction + Treatment Download Section PDF Listen +++ ++ Treat underlying lung disease Oxygen, salt and fluid restriction, and diuretics, often in combination Inotropic agents are useful when acute decompensation occurs Compensated cor pulmonale has the same prognosis as the underlying lung disease Average life expectancy is 2–5 years when signs of heart failure appear, but survival is significantly longer when uncomplicated emphysema is the cause