MRCP revision battle 37.4: Cor pulmonale

Cor pulmonale is right heart failure caused by chronic pulmonary hypertension

Normal pulmonary artery pressure = 15mmHg.

Pulmonary hypertension = pulmonary artery pressure >25mmHg at rest or >30mmHg on exercise

Causes of cor pulmonale include:

• lung disease - of which COPD is by far the commonest
• pulmonary vascular disease - PE
•  rib cage deformity

Presentation is:

• dyspnoea
• fatigue
• syncope

Signs:

• raised JVP, a and v waves
• RV heave
• loud P2
• pansystolic murmur - tricuspid regurgitation
• peripheral oedema
• hepatomegaly
• Graham Steell murmur = high-pitched early diastolic murmur, best heard 2nd left intercostal space with pt in full inspiration = pulmonary regurgitation

Investigations:

• CXR
• FBC - look for secondary polycythaemia
• ECG - R axis deviation, right ventricular hypertrophy

Management:

• treat cause
• treat symptoms
• ?heart-lung transplant

Next up: alpha-1 antitrypsin deficiency