Cor Pulmonale Flashcards
What is cor pulmonale?
Right heart failure due to chronic pulmonary arterial hypertension.
General causes of cor pulmonale.
Lung disease
Pulmonary vascular disease
Thoracic cage abnormalities
Neuromuscular disease
Hypoventilation
Cor pulmonale causes of lung disease.
COPD
Bronchiectasis
Pulmonary fibrosis
Severe chronic asthma
Lung resection
Pulmonary vascular disease causing cor pulmonale.
PE
Pulmonary vasculitis
Primary pulmonary hypertension
ARDS
Sickle-cell disease
Parasite infection
Thoracic cage abnormalities causing cor pulmonale.
Kyphosis
Scoliosis
Thoracoplasty
Neuromuscular diseases causing cor pulmonale.
MG
Poliomyelitis
Motor neuron disease
Hypoventilation causing cor pulmonale.
Sleep apnoea
Enlarged adenoids in children
Clinical features of cor pulmonale.
SOB
Fatigue
Syncope
Signs of cor pulmonale.
Cyanosis
Tachycardia
Raised JVP with prominent a and v waves.
RV heave
Loud p2
Pan-systolic murmur
Early diastolic Graham Steell murmur
Hepatomegaly
Oedema
Investigations done in cor pulmonale.
Bloods - FBC, Hb and haematocrit (up)
ABG - hypoxia with or without hypercapnia.
CXR
ECG
CXR findings in cor pulmonale
Enlarged right atrium and ventricle
Prominent pulmonary arteries
ECG findings in cor pulmonale.
Right axis deviation
Right ventricular hypertrophy/strain
Management of cor pulmonale.
Treat underlying cause like COPD and pulmonary infection.
Treat resp failure
Treat cardiac failure
Consider venesection if haematocrit is >55%
Consider heart-lung transplantation in young patients.
How to treat resp failure due to cor pulmonale.
Give 24% o2 if PaO2 <8kPa
Monitor BAG and gradually increase O2 if PaCO2 is stable.
In COPD patients long-term o2 therapy for 16h/d increases survival.
How to treat cardiac failure in cor pulmonale.
Diuretics such as furosemide 40-160mg/24h PO.
Monitor U&Es and give amiloride or potassium supplements if necessary.
Alternatively spironlactone.
