Cor Pulmonale

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

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%

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

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