Cor pulmonale: The Daily PANCE Blueprint
A 52-year-old Caucasian man comes to the office due to 3 days of progressive dyspnea and purulent sputum production. The patient takes albuterol and tiotropium bromide for moderate chronic obstructive pulmonary disease. His medical history is relevant for a 40-pack-year smoking history, type II diabetes mellitus, hyperlipidemia, and coronary artery stenting 2 years ago. Physical exam shows a barrel-shaped chest, inspiratory crackles, hepatojugular reflux, pulsus paradoxus, and ventricular gallop. His temperature is 38.1°C (100.5°F), pulse is 130/min, respirations are 28/min, blood pressure is 130/84 mmHg, and pulse oximetry on room air shows an oxygen saturation of 86%. This patient most likely has which of the following conditions?
A. Systolic heart failure
B. Cor pulmonale
C. High-output heart failure
D. Diastolic heart failure
Answer and topic summary
The answer is B -> Cor Pulmonale
Signs and symptoms of right heart failure in the context of a pulmonary disease, such as chronic obstructive pulmonary disease, are also known as cor pulmonale.
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Pearls
Cor pulmonale is right ventricular enlargement and eventually failure secondary to a lung disorder that causes pulmonary artery hypertension
- Lung disorders such as PE, vasculitis, ARDS, COPD (most common), asthma, and ILD cause pulmonary artery hypertension
- Pulmonary artery hypertension then leads to right ventricular failure
- Findings include peripheral edema, neck vein distention, hepatomegaly, and a parasternal lift
Diagnosis
The diagnosis of cor pulmonale is usually made with an echocardiogram → increased pressure in the pulmonary arteries and right ventricle
- Spirometry can be done to look for chronic lung disease
- The gold standard diagnostic test to directly measure pulmonary pressures and assess for response to vasodilating medications is a right heart catheterization
Treatment
Treatment of chronic cor pulmonale generally focuses on the underlying pulmonary disease
- Early identification and treatment of the cause are important before cardiac structural changes become irreversible
- Although patients may have significant peripheral edema, diuretics are not helpful and may be harmful; small decreases in preload often worsen cor pulmonale
- Right ventricular ischemia or pulmonary artery stretching can cause anginal chest pain in cor pulmonale that does not respond to nitrates
Smarty PANCE Content Blueprint Review:
Covered under ⇒ PANCE Blueprint Pulmonary ⇒ ⇒
