Saturday, 30 October 2010

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

  • 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

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

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

Next up: alpha-1 antitrypsin deficiency