Cor pulmonale

definition:
pulmonary heart disease, excluding congenital heart disease, or right heart disease induced by left heart

etiology:
any pulmonary vascular or parenchymal disease can lead to cor pulmonale
50% cases were due to COPD

pathophysiology:
RV failure due to elevated pulmonary vascular pressure
acute: RV dilation without hypertrophy
chronic: RV dilation and hypertrophy

symptoms and signs
dyspnea, orthopnea, limbs edema, ascites
holosystolic murmur (TR murmur), increased with inspiration (Carvallo's sign)
Prominent V waive

diagnosis
1. exclude LV failure induced RV failure
2. EKG: P pulmonale, RV hypertrophy, right axis deviation
3. EKG: engorged pulmonary artery

treatment:
1. treat underlying pulmonary diseases
2. diuretics
3. digoxin: unclear role, should be administered with low dose