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2.1
Acute Cor Pulmonale
Cor Pulmonale Acute

Presentation

A male patient, 42 years old, presented with a large mass in the right atrium, being scheduled for removal of the tumor. [ncbi.nlm.nih.gov]

Only bronchiectasis was still present. He was kept on antiretroviral regimen, SMZ/TMP, and chloroquine. He showed good adherence. [scielo.br]

If peripheral edema is present, diuretics may seem appropriate, but they are helpful only if LV failure and pulmonary fluid overload are also present. Diuretics should be used cautiously because small decreases in preload often worsen cor pulmonale. [msdmanuals.com]

Respiratoric

  • Nasal Flaring

    The patient had nasal flaring, intercostal and subcostal retractions, and keeled chest. Abdomen was depressible; liver was 3 cm from the right-costal border, while spleen was 6 cm from the left-costal border. [ncbi.nlm.nih.gov]

Cardiovascular

  • Heart Disease

    Heart Diseases, Pulmonary, Pulmonary Heart Disease, Pulmonary Heart Diseases, COR PULMONALE, Pulmonary heart disease, unspecified, cardiopulmonary disease, DISEASES PULM HEART, PULM HEART DISEASES, HEART DIS PULM, HEART DISEASES PULM, PULM HEART DIS [fpnotebook.com]

    the chronic pulmonary heart disease ; co rpulmonale; chronic pulmonary heart disease s; Pneumocardial disease s; co r pulmonale; Co r pneumonale; chronic pulmonary heart diseaes ; Co r-pulmonale; Cardiopulmonary disease 收藏 肺 心病 Pulmonary heart disease [scidict.org]

    Pulmonary heart disease Pulmonary heart disease, or cor pulmonale, describes right-heart dysfunction due to pulmonary hypertension. [acphospitalist.org]

    What is Pulmonary Heart Disease – Cor Pulmonale Statistics on Pulmonary Heart Disease – Cor Pulmonale Risk Factors for Pulmonary Heart Disease – Cor Pulmonale Progression of Pulmonary Heart Disease – Cor Pulmonale Symptoms of Pulmonary Heart Disease – [myvmc.com]

    […] calcified coronary lesion I25.89 Other forms of chronic ischemic heart disease I25.9 Chronic ischemic heart disease, unspecified I26 Pulmonary embolism I26.0 Pulmonary embolism with acute cor pulmonale I26.01 Septic pulmonary embolism with acute cor [icd10data.com]

  • Tachycardia

    […] a change in structure and function of the right ventricle of the heart as a result of a respiratory disorder. keuhkosydänsairaus noun Cardiac disorders Common: congestive heart failure/cardiac dysfunction, pericardial effusion, arrhythmia (including tachycardia [fi.glosbe.com]

    Other ECG changes that may be seen include: Right bundle branch block (usually due to RVH) Multifocal atrial tachycardia – a rapid, irregular atrial tachycardia with at least 3 distinct P wave morphologies (associated with increased mortality in patients [lifeinthefastlane.com]

    CONCLUSION: Evaluation of right ventricular function by TEE in a group of 75 ARDS patients submitted to protective ventilation revealed the persistence of a 25% incidence of ACP, resulting in detrimental hemodynamic consequences associated with tachycardia [ncbi.nlm.nih.gov]

    Don’t forget about tachycardia! Tachycardia is the most likely EKG finding in a patient with acute PE. This tachycardia is usually of the sinus variety, although some may present with atrial fibrillation or atrial flutter. [ditchdocem.com]

    myocardial infarction, pericarditis, ventricular arrhythmia (including ventricular tachycardia), angina pectoris, cardiomegaly Rare: cor pulmonale, myocarditis, acute coronary syndrome sk Zabijeme Maxine ak ihneď neopustíš telo! [sk.glosbe.com]

  • Increased Jugular Venous Pressure

    CLINICAL ASSESSMENT OF COR PULMONALE: PLACE OF NON-INVASIVE METHODS The clinical signs of cor pulmonale are relatively insensitive6 and some of them (signs related to an increased jugular venous pressure) are often obscured by hyperinflation of the chest6 [ncbi.nlm.nih.gov]

Workup

Presentation Outline <ul><li>Definition </li></ul><ul><li>Epidemiology/Classification </li></ul><ul><li>Clinical manifestations </li></ul><ul><ul><li>Symptoms </li></ul></ul><ul><ul><li>Signs </li></ul></ul><ul><li>Diagnostic workup & Differential Diagnosis [slideshare.net]

Electrocardiography and chest radiography should usually be incorporated into the diagnostic workup. The most frequent electrocardiographic abnormality is the inversion of T waves in the anterior leads, especially leads V1 to V4. [tmj.ro]

Clinical value of thin-collimation CT in the diagnostic workup of pulmonary embolism. AJR 2000; 175:407-411 [Abstract] [Google Scholar] 9. Ghaye B, Szapiro D, Mastora I, et al. [ajronline.org]

Axis

  • Right Axis Deviation

    Right axis deviation, dominant R wave in V1 and deep S wave in V6 suggest right ventricular hypertrophy due to cor pulmonale. [lifeinthefastlane.com]

    Other ECG findings in PE include right bundle-branch block, right axis deviation, atrial fibrillation, and T-wave changes ( 2, 3 ). [ispub.com]

    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 [radiopaedia.org]

    ECG evidence of RV hypertrophy (eg, right axis deviation, QR wave in lead V1, and dominant R wave in leads V1 to V3) correlates well with degree of pulmonary hypertension. [msdmanuals.com]

Serum

  • Base Deficit

    deficit >5 mEq/l) constituted group 3. [ncbi.nlm.nih.gov]

    In fact, we have observed in this setting that only patients with metabolic acidosis, defined by a base deficit greater than 5 mMole/L, had a poor prognosis (59% mortality rate), whereas 97% of patients with acute cor pulmonale and no metabolic acidosis [atsjournals.org]

QT, RR, ST Intervals

  • ST Elevation

    ST-segment abnormalities: 1 mm ST elevations in DI, DII and aVL. ( Fig. 1 ) The chest radiography showed: normal heart size (cardio-thoracic ratio = 0.48), focal oligemia at the level of the upper left lung lobe, upper and middle right lung lobe, enlarged [tmj.ro]

Blocks

  • Incomplete Right Bundle Branch Block

    New-onset right-bundle branch block or atrial fibrillation is uncommon. [tmj.ro]

P Wave

  • P Pulmonale

    With development of cor pulmonale, the following additional changes are seen: Right atrial enlargement (P pulmonale) Right ventricular hypertrophy 3. [lifeinthefastlane.com]

    Tall tented p-pulmonale may also be seen. 3) Echocardiography may show dilatation and also allows indirect measurement of pulmonary artery pressures. [myvmc.com]

    […] include the following:[1] Chest x-ray – right ventricular hypertrophy, right atrial dilatation, prominent pulmonary artery ECG – right ventricular hypertrophy, dysrhythmia, P pulmonale (characteristic peaked P wave) Thrombophilia screen- to detect chronic [en.wikipedia.org]

    ECG changes in Cor Pulmonale include right axis deviation, R/S amplitude ratio in V1 greater than 1, R/S amplitude ratio in V6 less than 1 and P-Pulmonale pattern (Klinger et.al, 1991). [asrn.org]

    FindingsX-Ray : Prominent pulmonary hilum pulmonary artery dilatation Rt MPA > 20 mmEKG : P- pulmonale, RAD, RVHEchocardiography : RVH, TR, Pulm. [vdocuments.mx]

Hypertrophy

  • Right Ventricular Hypertrophy on ECG

    Over time, this chronic elevation of pulmonary arterial pressures results in compensatory right atrial and right ventricular hypertrophy. Typical ECG Findings in COPD 1. [lifeinthefastlane.com]

Treatment

We experienced a patient with acute cor pulmonale during high positive-pressure ventilation for the treatment of severe acute respiratory distress syndrome. [ncbi.nlm.nih.gov]

Abstract Ethanol is an effective ablative agent used for the treatment of certain solid organ tumors and vascular malformations (VMs). [osti.gov]

Specific Treatment Drugs and dosages Refractory cases 5. [cancertherapyadvisor.com]

Treatment is directed at the cause. [msdmanuals.com]

The median patient survival time following oxygen treatment was 9 days [ 3 ]. [kjim.org]

Prognosis

Prognosis Prognosis depends strongly on the underlying cause of the acute right heart syndrome. In pulmonary embolism, prognosis is quite good if the patient can be stabilized hemodynamically, but very poor (> 50% mortality) if not. [cancertherapyadvisor.com]

Prognosis: The prognosis of cor pulmonale is variable-dependant upon the underlying pathology. [ncbi.nlm.nih.gov]

Prognosis of Pulmonary Heart Disease – Cor Pulmonale The prognosis of pulmonary heart disease depends on the underlying causes. [myvmc.com]

Etiology

Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10coded.com]

Our case represents one of the first reports of a rare etiology for acute cor pulmonale--hypersensitivity pneumonitis. [ncbi.nlm.nih.gov]

As a general rule, the treatment consists in rapidly reducing resistance to blood flow in the pulmonary circulation, obtained by a specific strategy according to etiology. [journals.lww.com]

The etiologies which can enhance right-sided afterload can be broadly categorized into two groups. [pathwaymedicine.org]

Epidemiology

Pocket Guidelines on Acute Pulmonary Embolism Published in 2014 Reference Acute PE Mobile App with interactive tools Published in 2014 Reference 40 Slides on Acute PE Table of contents: Full Text (ESC Clinical Practice Guidelines) Preamble Introduction Epidemiology [escardio.org]

Epidemiology The incidence of acute cor pulmonale depends on the underlying cause. [cancertherapyadvisor.com]

Finally, transplantation of single/double lung in extreme cases of cor pulmonale is also an option.[1] Epidemiology[edit] The epidemiology of pulmonary heart disease (cor pulmonale) accounts for 7% of all heart disease in the U.S [15] According to Weitzenblum [en.wikipedia.org]

[…] and Human Services, Public Health Service, Centers for Disease Control, National Institute for Occupational Safety and Health, DHHS (NIOSH) Publication No. 86-102, 1986 Sep; :719-736 Abstract Cor pulmonale is reviewed with regard to its occupational epidemiology [cdc.gov]

The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. Journal of Autoimmunity 2020: 102433. - Sola A, Rodríguez S, Cardetti M y Dávila C. COVID-19 perinatal en América Latina. Rev. Panam. [revcorsalud.sld.cu]

Pathophysiology

Abstract The ventilatory strategy for ARDS has been regularly amended over the last 40 years as knowledge of the pathophysiology of ARDS has increased. [ncbi.nlm.nih.gov]

“Acute right ventricular failure — from pathophysiology to new treatments”. Intensive Care Med. vol. 30. 2004. pp. 185Thorough review of all aspects of acute cor pulmonale, with an emphasis on pathophysiology and diagnosis. [cancertherapyadvisor.com]

Springer Science & Business Media, ٠٥‏/٠٥‏/٢٠٠٨ - 444 من الصفحات This timely volume addresses the areas of pathophysiology and therapy of pulmonary hypertension, which have seen exciting developments over the past decade. [books.google.com]

"Acute Right Ventricular Failure in the Setting of Acute Pulmonary Embolism or Chronic Pulmonary Hypertension: A Detailed Review of the Pathophysiology, Diagnosis, and Management". [en.wikipedia.org]

Prevention

Your doctor may need to adjust your treatment plan to help prevent cor pulmonale. You can prevent cor pulmonale by taking care of your heart and lungs. [healthline.com]

Rapidly find the answers you need with separate sections on diseases and disorders, differential diagnosis, clinical algorithms, laboratory results, and clinical preventive services, plus an at-a-glance format that uses cross-references, outlines, bullets [books.google.com]

Prevention Cor pulmonale is best prevented by prevention of COPD and other irreversible diseases that lead to heart failure. Smoking cessation is critically important. [encyclopedia.com]

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