Cor pulmonale: The Daily PANCE Blueprint

Cor pulmonale: The Daily PANCE Blueprint

Which of the following is the most common cause of acute cor pulmonale?

A. Cardiac tamponade
B. Pulmonary embolism
C. Mitral regurgitation
D. Congestive heart failure
E. Portopulmonary syndrome

Answer and topic summary

The answer is B. Pulmonary embolism

The most common cause of acute cor pulmonale is a massive pulmonary embolism (PE). Cor pulmonale is defined by RV failure/enlargement due to a pulmonary issue. The reason a PE leads to acute right heart failure is because a PE is a mechanical obstruction that increases vascular resistance in lungs and increases RV afterload. The RV can’t unload sufficiently and this results in dilation of the RV. The dilated RV impedes on the LV, leading to decreased LV output and decreased supply to the coronary arteries. It also causes RV wall tension/pressure to build and thus coronary perfusion is impeded to the right heart, further leading to ischemia. Also, the dilation of the RV can lead to tricuspid regurgitation, which further reduces blood flow. As the RV becomes ischemic, it can’t contract as well and this further decreases RV output and LV output — leading to a dangerous cycle toward shock. You can risk stratify the degree of RV compromise by getting an echocardiogram, BNP, & troponin.

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Covered under ⇒ PANCE Blueprint PulmonaryPulmonary Circulation Cor pulmonale

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