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Physical and Systemic Signs of Cor Pulmonale

In this article we will discuss the Physical and Systemic Signs of Cor Pulmonale. So, let’s get started.

Physical Signs

  • Patient is orthopnoic, sits with elbows supported on a table and legs dangling by the side of the bed.
  • Purse-lip breathing and cyanosis (lips, tongue, and buccal cavity) will be present in patients with COPD with acute exacerbation.
  • Periorbital edema
  • Neck veins: Distended with raised JVP and ‘VY’ collapse due to tricuspid regurgitation.
  • Peripheral edema

Systemic Signs

  • Respiratory system may show signs of COPD (barrel-shaped chest, restricted chest movements and expansion, hyper-resonant note and vesicular breathing with prolonged expiration, muffled breath sounds).
  • Signs of RV hypertrophy or failure, e.g. parasternal heave, loud P2, midsystolic and early diastolic (Grahm-steel) murmur and pansystolic or holosystolic murmur of tricuspid regurgitation (Carvallo’s sign) may be present.
  • Abdominal examination: Abdomen may be distended with tender hepatomegaly. Hepatojugular reflex may be present. Ascites may also be present.
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Management of Cor Pulmonale

In this article, we will discuss in brief the Management of Cor Pulmonale. So, let’s get started.

Management

  • The patient is rested in a supine comfortable position.
  • Treatment of the basic cause.
  • The patient is advised to avoid smoking.
  • O2 therapy: O2 therapy to be given intermittently.
  • Salt restriction and diuretics: Salt restriction is advised to avoid fluid retention and RV volume overload. Intravenous diuretics such as furosemide, etc are given to relieve fluid overload.
  • Bronchodilators: They are given intravenously to relieve bronchospasm (due to acute exacerbation) and to improve oxygenation.
  • Carbonic-anhydrase inhibitor, e.g. acetazolamide to be given in order to relieve hypercapnia.
  • Antibiotics are given to treat superadded infection causing acute exacerbation.
  • Reduction of afterload by angiotensin-converting enzyme inhibitor (ACE inhibitors) in patients with left heart failure causing right heart failure.

Clinical Features of Cor Pulmonale

In this article, we will discuss the Clinical Features of Cor Pulmonale. So, let’s get started.

Clinical Features

Productive cough

Dyspnea

Chest discomfort

Headache

Abdominal pain

Lower extremity swelling

Ascites

Physical Signs include:

Orthopnea

The patient sits with elbows supported on a table and legs dangling by the side of the chest

Pursed lip breathing and cyanosis (presents in patients with COPD with acute exacerbation)

Periorbital edema

Jugular venous distention (raised JVP) and ‘VY’ (wave) collapse due to tricuspid regurgitation

Peripheral edema

Systemic Signs

Respiratory system may show signs of COPD (barrel-shaped chest, restricted chest movements and expansion, hyper-resonant note and vesicular breathing with prolonged expiration, muffled breath sounds)

Signs of RV hypertrophy or failure e.g. parasternal heave, loud P2, midsystolic and early diastolic (Graham-steel) murmur and pansystolic or holosystolic murmur of tricuspid regurgitation (Carvallo’s sign) may be present.

Abdominal distention may be present along with tender hepatomegaly. Hepatojugular reflex may be present.

Sign and Symptoms of Cor pulmonale

In this article, we will discuss about various Sign and Symptoms of Cor pulmonale. So, let’s get started.

Sign and Symptoms

Fatigue

Dyspnea

Abdominal distention

Palpitations

Lower extremity edema

Chest pain

Fainting spells/Syncope

Cyanosis (bluish discoloration of fingers and lips)

Cough or increased mucus production

Increased right ventricular pressure

Left parasternal systolic lift

Loud pulmonic component of second heart sound

Murmurs of functional tricuspid

Jugular venous distention

Pulmonary insufficiency

RV gallop rhythm increased during inspiration

Hepatomegaly

Causes of Cor pulmonale

In this article, we will discuss about various Causes of Cor pulmonale. So, let’s get started.

Causes

Diseases of lung parenchyma

Chronic Obstructive Pulmonary Diseases such as emphysema and chronic bronchitis

Cystic fibrosis

Pulmonary fibrosis

Sarcoidosis

Bronchiectasis

Hypoventilation syndrome

Pulmonary vascular disease

Primary pulmonary hypertension

Thromboembolic pulmonary hypertension

Venoocclusive disease

Schistosomiasis

Chest wall disorder

Kyphoscoliosis

Neuromuscular disorders

Poliomyelitis

Myasthenia gravis

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