Cor Pulmonale

Cor Pulmonale¶

Definition¶

• Refers to impaired function of the right ventricle caused by pulmonary hypertension (RHF due to Pulmonary Hypertension)
• 25% of COPD develop cor pulmonale, PVD (thromboembolic), OSA, CF
• Not due to Left sided or Congenital HD

Etiology¶

• COPD (MC)
• ILD
• PVD (thromboembolic)
• OSA
• CF

Symptoms¶

• Dyspnea on exertion, fatigue, lethargy
• Exertional Angina (due to increased myocardial demand)
• Exertional Syncope (due to decreased CO)
• Acute to gradual onset (PE)

Exam¶

• Peripheral edema
• JVD w/ prominent 'a' wave
• Loud S2 (loud P2)
• Palpable RV heave
• Pulsatile liver from congestion
• Tricuspid regurgitation, RV 3 heart sound
  • ± hepatomegaly, ascites
• End-stage: hypotension, tachycardia, cardiogenic shock

Diagnosis¶

Gold Standard¶

• Right Heart Catheterization (RHC)
  • Abnormal: showing right ventricular dysfunction, pulmonary hypertension, and no left heart disease

Imaging¶

• CXR: Enlarged central pulmonary arteries and loss of retrosternal air space due to RVH
• EKG: Partial/complete RBBB, right axis deviation, RVH Atrial enlargement, RV strain pattern
• Echocardiography: Pulmonary hypertension, dilated RV, tricuspid regurgitation

Treatment¶

• O₂
  • Most important intervention for hypoxic patients
• Diuretics + Afterload Reduction
  • Loop diuretics
• Treat underlying disease
  • Manage COPD, OSA, CF, etc.
• IV Inotropes (Milrinone, Dobutamine)
  • When severe hypotension develops