Cor Pulmonale

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Cor pulmonale is defined as an alteration in the structure (hypertrophy or dilation) and function of the  right ventricle (RV) of the heart caused by a primary disorder of the respiratory system resulting in  pulmonary hypertension.

Clinical Presentation

  • Fatigue
  • Tachypnea
  • Exertional dyspnea
  • Cough
  • Anginal chest pain
  • Syncope with exertion
  • Lower limb edema
  • Raised JVP
  • Wheezes and crackles
  • Systolic murmur of tricuspid regurgitation.
  • Shortness of breath
  • Wheezing
  • Chronic wet cough
  • Swelling of the abdomen with fluid
  • Swelling of the ankles and feet
  • Enlargement of the liver
  • Bluish discoloration of face
  • InvestigationsElectrocardiography (ECG)
  • Echocardiography
  • ABG
  • BNP
  • CXR
  • Chest computed tomography
  • (CT)+/-CTPA
  • Ventilation/perfusion (V/Q) scanning
  • Cardiac magnetic resonance (CMR) (as indicated)
  • Other test to rule out etiology
  • FBP/Hematocrit level
  • Serum alpha1-antitrypsin
  • Antinuclear antibody (ANA)
  • Anti-SCL-70 antibodies
  • Coagulations studies (serum levels of  proteins  S  and  C,  antithrombin III,  factor  V  Leyden,  anticardiolipin antibodies, homocysteine)

Non-pharmacological Management

  • Oxygen therapy when PaO2 is less 55mmHg
  • Pulmonary embolectomy
  • Uvulopalatopharyngoplasty (UPPP)
  • Surgical embolectomy
  • Lung transplant
  • Pulmonary rehabilitation

Pharmacological Treatment 

Treat Heart Failure (right sided heart failure) 

B: nifedipine ER (PO) 30mg 12hourly 

Pulmonary Hypertension management 

S: sildenafil (PO) 5mg -20mg 8hourly 

OR 

warfarin or rivaroxaban for indicated patient (For dosage refer to Pulmonary embolism management)