Cor pulmonale

Cor pulmonale is defined as a failure of the structure and function of the right ventricle in the absence of left ventricular dysfunction. It is caused by an underlying primary disorder of the respiratory system. It has a generally chronic and slowly progressive course, although acute onset or worsening with life-threatening complications can occur.

Clinical presentation

ECG

• dominant R wave in lead V1 ¹⁰
  • defined as an R wave height > 7 mm or R/S > 1
  • accompanied by dominant S waves in lead V6
• right axis deviation
• secondary repolarization abnormalities
  • simultaneous involvement of the right precordium (V1-4) and inferior limb leads (II, III, aVF)
  • depressed ST segments with T wave inversion
• right atrial enlargement

Pathology

Aetiology

• chronic obstructive pulmonary disease
• pulmonary manifestations of cystic fibrosis
• interstitial lung disease
• massive pulmonary emboli: for acute cor pulmonale
• acute respiratory distress syndrome: for acute cor pulmonale
• pulmonary sarcoidosis

Radiographic features

Plain radiograph

• central pulmonary artery enlargement ⁷
• changes consistent with the underlying pulmonary disease as outlined above

Echocardiography

May show dilatation of the left ventricular cavity or thickening of the right ventricular free wall ⁶.

Treatment and prognosis

Cor pulmonale generally carries a poor prognosis. Long-term oxygen therapy is often considered the main treatment option.

History and etymology

From the Latin, cor: 'heart', and pulmonale, 'relating to the lungs', ultimately from the Latin pulmo meaning 'lung'. Therefore 'heart secondary to / relating to the lungs'.

See also

• right heart failure
• right heart strain