Cor pulmonale


Symptoms: Dyspnea, pallor, sweating, cough productive of sputum or dry; cigarette smoking.
Special signs: Signs of acute right ventricular failure such as rapid pulse of small amplitude; pallor, sweating, hypotension, distended neck veins; large "v" waves; due to tricuspid regurgitation; liver is pulsatile, tender with hepatomegaly; tricuspid regurgitation murmur at left sternal border; S4 gallop sound. Wheezes, basal rales; pulmonary hypertension causes cardiac thrust in 2nd left intercostal space adjacent to sternum; an unusually loud second component of the 2nd heart sound in the same area and occasionally a murmur of pulmonary valvular insufficiency. If there is a right heart failure it may include tricuspid insufficiency and right ventricular gallop sound; Transitory arrythmia is common and may occur in severe hypoxia or following respiratory alkalosis induced by mechanical hyperventilation.
Special investigations:  ECG normal especially in Cor pulmonale following COLD but may show P-pulmonale in leads II, III, AVF. Xray shows right ventricular hypertrophy . There is also evidence of chronic inflammation of the bronchi leading to increased ratio of mucous glands with increase in Reid index- Gland/wall ratio from 0.4 to 0.5 due to hypertrophy of glands; Also increase in bronchial muscle; low PO2; PCO2 high in extreme cases;PO2 and PCO2 may rise after exercise; polycythemia; low expiratory flow rate; low FEV1; increase residual volume; total lung capacity normal; carbon monoxide transfer (diffusing capacity) is normal or light reduced; elevated JVP.

Cor pulmonale means enlargement of right ventricle following respiratory disease such as COLD and other abnormalities of the lung, thorax, pulmonary circulation  or ventilation. It may lead to acute right heart failure. Acute cor pulmonale may arise from pulmonary emboli while chronic one may be due to pulmonary vascular disease. Cor pulmonale may also arise from lung parenchymal disease.





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Creator: Oluwole Ogunranti