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Cor pulmonale

Cor pulmonale is right ventricle enlargement Q with or without failure Q secondary to lung parenchyma, pleura or chest wall disease.


Causes of cor pulmonale

  1. Lung disease
    1. COPD (M/C cause)
    2. Bronchiectasis
    3. Pulmonary fibrosis
  2. Pulmonary vascular disease
    1. Pulmonary emboli
    2. Pulmonary vasculitis
    3. Primary pulmonary hypertension
  3. Thoracic cage abnormality
    1. Kyphosis
    2. Scoliosis
    3. Thoracoplasty
  4. Neuromuscular disease
    1. Myasthenia gravis
    2. Poliomyelitis
    3. Motor neurone disease
  5. Hypoventilation
    1. Sleep apnea

Clinical features

  1. Symptoms include dyspnea, fatigue, or syncope.
  2. Signs: cyanosis, tachycardia; raised JVP with prominent v wave (Carvallo sign); RV heave; loud P2 pansystolic murmur (tricuspid regurgitation); early diastolic Graham Steel murmur, hepatomegaly and edema.
Extra Edge:

Cor pulmonale is the commonest cause of tricuspid regurgitation Q.

  1. Investigations: Increase Hb and ↑hematocrit (secondary polycythemia) Q.
  2. CXR: enlarged right atrium and ventricle, prominent pulmonary arteries.
    ECG: P pulmonale; right axis deviation; right ventricular hypertrophy/strain.
Extra Edge: 

Cor pulmonale is the commonest cause of tricuspid regurgitation Q.


Types of Cor pulmonale

  1. Acute Cor pulmonale                                
    The most common cause is a sudden, massive, pulmonary embolism
  2. Chronic Cor pulmonale The most common cause is COPD

Note: Chronic Cor pulmonale is associated with prominence of upper lobe veins.



  1. Treat underlying cause
  2. Treat respiratory failure.
  3. Treat cardiac failure with diuretics such as furosemide.

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