Ver el código de «Cor pulmonale»

==Background==
*Remodeling of right ventricle in response to pulmonary pathology
*Often caused by [[COPD]], [[pulmonary hypertension]], [[PE]], [[ARDS]]

==Clinical Features==
===Pathophysiology===
*Pulmonary vasoconstriction (hypoxia, acidemia)
*Destruction of pulmonary vasculature by emphysema, ILD
*Increased blood viscosity ([[sickle cell disease]], polycythemia)
===Chronic===
*[[RVH]]
===Acute===
*RV dilation
===Signs and Symptoms===
*[[Cough]]
*[[Dyspnea]]
*[[Tachypnea]]
*[[Hemoptysis]]
*[[Syncope]]
*Peripheral edema
*Cyanosis

==Differential Diagnosis==
*Cardiovascular
**[[ACS]]
**[[Acute Valve Dysfunction]]
**[[Aortic Dissection]]
**[[Dysrhthymia]]
**[[Endocarditis]]
**[[Hypertensive Emergency]]
**[[Pericardial Tamponade]]
*Pulmonary
**[[COPD]]
**[[PE]]
**[[PNA]]
*Other
**Pure volume overload
***[[Renal Failure]]
***Post-[[Transfusion]]
**[[Sepsis]]

==Diagnosis==
===Blood tests===
*CBC (polycythemia)
*ABG (oxygenation, acid-base status)
*alpha-1-antitrypsin
*ANA
*Coagulation studies (protein C/S, factor V Leiden etc)
===CXR===
*Enlarged pulmonary arteries
*Cardiomegaly
*Decreased retrosternal air space
===ECG===
*[[RVH]]
*Right axis deviation
*[[Right bundle branch block]]
*R:S ratio > 1 in V1
*TWI in V1-3 in acute R heart strain
*S1 Q3 T3 in acute R heart strain
*Large P wave in II, III, aVF
*Arrhythmia (PAC, SVT, MFAT, A-fib, A-flutter)

===Echo===
*Increased RV thickness
*RV dilation
*Tricuspid insufficiency
*High estimated PA pressures
*Septal bowing into LV
===CTPA for PE===
===V/Q scan for PE===

==Management==
*Treat underlying disease
*Fluids, vasoconstrictors to support BP in acute setting
*Oxygen therapy: decreases pulmonary vasoconstriction
*Diuretics: decrease RV filling volume
*[[Calcium channel blockers]]: vasodilate the pulmonary arteries
*Beta agonists (epoprostenol, iloprost): bronchodilate
*Phlebotomy for severe hypoxia leading to polycythemia
*Lung transplant or heart-lung transplant as last resort

==Disposition==


==See Also==
*[[Pulmonary Embolism]]
*[[COPD]]

==External Links==

==References==
<references/>

[[Category:Pulmonary]][[Category:Cardiology]]