In cor pulmonale the right ventricle enlarges and fails because a lung disease or chronic low oxygen raises the pressure in the lung arteries. COPD is the most common cause, and correcting the low oxygen is the core of treatment.
Key symptoms
- Shortness of breath that worsens with effort
- Swelling of the ankles and legs
- Fatigue and less exercise tolerance
- Chest discomfort or fainting with exertion
- Cough and wheeze from the underlying lung disease
What you find on exam
- Raised jugular venous pressure
- Loud second heart sound over the pulmonic area; right ventricular heave
- Leg edema, enlarged tender liver, sometimes ascites
- Low oxygen saturation or cyanosis
- Signs of chronic lung disease: barrel chest, wheeze, clubbing
Tests
- Echocardiogram: enlarged right ventricle and high estimated pulmonary pressure
- ECG: right axis deviation, tall P waves, right ventricular hypertrophy
- Chest X-ray, arterial blood gas and spirometry for the lung cause
- BNP and blood count (high hematocrit); CT angiogram if clots are suspected
Treatment basics
- Long-term oxygen for chronic low oxygen levels
- Treat the lung disease: bronchodilators for COPD, CPAP for sleep apnea
- Diuretics such as furosemide for fluid overload, used with care
- Anticoagulation if clots in the lungs are the cause
- Smoking cessation, vaccines and pulmonary rehabilitation
Red flags
- Low blood pressure or fainting
- Growing confusion or sleepiness from high carbon dioxide
- Sudden worse breathlessness with chest pain
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.