Cor Pulmonale

Cor pulmonale is right sided heart failure caused by respiratory disease. The increased pressure and resistance in the pulmonary arteries (pulmonary hypertension) results in the right ventricle being unable to effectively pump blood out of the ventricle and into the pulmonary arteries. This leads to back pressure of blood in the right atrium, the vena cava and the systemic venous system.

 

Respiratory Causes

  • COPD is the most common cause
  • Pulmonary Embolism
  • Interstitial Lung Disease
  • Cystic Fibrosis
  • Primary Pulmonary Hypertension

 

Presentation

Often patients with early cor pulmonale are asymptomatic. The main presenting complaint is shortness of breath. Unfortunately shortness of breath is also caused by the the chronic lung diseases that lead to cor pulmonale. Patients may also present with peripheral oedema, increased breathlessness of exertion, syncope (dizziness and fainting) or chest pain.

Examine the patient for the signs of cor pulmonale:

  • Hypoxia
  • Cyanosis
  • Raised JVP (due to a back-log of blood in the jugular veins)
  • Peripheral oedema
  • Third heart sound
  • Murmurs (e.g. pan-systolic in tricuspid regurgitation)
  • Hepatomegaly due to back pressure in the hepatic vein (pulsatile in tricuspid regurgitation)

 

Management

Management involves treating the symptoms and the underlying cause. Long term oxygen therapy is often used. The prognosis is poor unless there is a reversible underlying cause.

 

Last updated November 2018
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