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Acute Cor Pulmonale


Presentation

  • CASE REPORT: 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]
  • Its main limitation concerned the left pulmonary artery, in which only one thrombus was visualized by TEE whereas six were present on helical CT, and lobar pulmonary arteries which could not be visualized with TEE.[ncbi.nlm.nih.gov]
  • We present a case of a 50-year-old woman who succumbed to acute cor pulmonale secondary to metastatic laryngeal carcinoma to the right ventricle with subsequent tumor emboli to the pulmonary vasculature.[ncbi.nlm.nih.gov]
  • Abstract A case of massive pulmonary embolism complicated by acute cor pulmonale and shock is presented.[ncbi.nlm.nih.gov]
  • In our case, a 41-year-old man with an unremarkable medical history presented with respiratory failure that led to death less than 48 h from the onset of symptoms.[ncbi.nlm.nih.gov]
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]
  • He had nasal flaring and retraction of intercostals and subcostals. Abdomen was depressible; liver was three cm from the right costal border while the spleen was six cm from the left costal border.[scielo.br]
Heart Disease
  • diseases I27.0 Primary pulmonary hypertension I27.1 Kyphoscoliotic heart disease I27.2 Other secondary pulmonary hypertension I27.20 Pulmonary hypertension, unspecified I27.21 Secondary pulmonary arterial hypertension Reimbursement claims with a date[icd10data.com]
  • Includes new information on congenital heart disease, morbid obesity, neurological diseases, infectious diseases, trauma and acute care, geriatric patients, genetic and metabolic diseases, and burn patients.[books.google.com]
  • Description: Pulmonary embolism without acute cor pulmonale Long Description: Pulmonary embolism without acute cor pulmonale The code I26.9 is NOT VALID for claim submission Code Classification: Diseases of the circulatory system (I00–I99) Pulmonary heart[healthprovidersdata.com]
  • .- ) I26-I28 Pulmonary heart disease and diseases of pulmonary circulation I26 Pulmonary embolism Includes: • pulmonary (acute) (artery) (vein) infarction • pulmonary (acute) (artery) (vein) thromboembolism • pulmonary (acute) (artery) (vein) thrombosis[coding-pro.com]
Tachycardia
  • 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]
  • 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.[insights.ovid.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]
  • 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]
  • For pulmonary embolism, the electrocardiogram (EKG) has been described to be neither sensitive nor specific ( 2 ), with the most commonly seen EKG abnormality seen in patients with PE is sinus tachycardia.[ispub.com]
Distended Neck Veins
  • neck veins with prominent a or v waves, and cyanosis may be seen. the heart and lung are intricately related. whenever the heart is affected by disease, the lungs will follow and vice versa. pulmonary heart disease is by definition a condition when the[allnurses.com]
  • On inspection, an increase in chest diameter, labored respiratory efforts with retractions of chest wall, distended neck veins with prominent a or v waves, and cyanosis may be seen.[medictests.com]
Facial Swelling
  • You’re not going to like this answer, but when my patients who have chronic cor pulmonale from COPD–in other words, they may oftentimes have a little pedal edema or a little facial swelling or extension of neck veins–come in acutely exacerbated, they[hcpro.com]

Workup

  • 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]
  • 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]
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 limb[radiopaedia.org]
  • ECG evidence of RV hypertrophy (eg, right axis deviation, QR wave in lead V 1 , and dominant R wave in leads V 1 to V 3 ) correlates well with degree of pulmonary hypertension.[msdmanuals.com]
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]
ST Elevation
  • 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 left descending pulmonary artery[tmj.ro]
Incomplete Right Bundle Branch Block
  • The electrocardiogram on admission showed a regular sinus rhythm with a ventricular rate of 90 beats per minute, a QRS axis at 70o, a 1 st degree atrioventricular block (PR interval 0.24 sec), an incomplete right bundle branch block and non-specific ST-segment[tmj.ro]
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]
  • […] test ) mPAP 25 mmHg at rest Pulmonary capillary wedge pressure : 15 mmHg in PH due to left heart disease Electrocardiography : right axis deviation due to right ventricular hypertrophy Incomplete or complete right bundle branch block In some cases, P[amboss.com]
  • 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]
  • . P pulmonale (large P wave ) in the inferior and anterior leads “ right atrial enlargement “. Right bundle branch block. Right precordial T-wave inversions. Delayed interinsicoid deflection of right precordial leads. 17.[slideshare.net]
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]
Hepatocellular Carcinoma
  • Autopsy revealed massive microscopic pulmonary tumour embolism and a multifocal hepatocellular carcinoma.[ncbi.nlm.nih.gov]
  • Intracardiac manifestation and pulmonary embolism of hepatocellular carcinoma (HCC) is a very rare finding and uncommon even at autopsy.[karger.com]
  • carcinoma. ( 25186945 ) 2014 14 Bedside cardiac testing in acute cor pulmonale. ( 24939650 ) 2014 15 Prevalence and prognostic value of acute cor pulmonale and patent foramen ovale in ventilated patients with early acute respiratory distress syndrome[malacards.org]
  • carcinoma. ( 12169988 ) GutiAcrrez-MacA-as A....De ZA![malacards.org]

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 Metastatic tumors to the heart are becoming more common due to improved survival afforded by advanced treatment of malignancies. Their presence should be sought in a cancer patient who develops new primary cardiac symptoms.[ncbi.nlm.nih.gov]
  • The median patient survival time following oxygen treatment was 9 days [ 3 ].[kjim.org]
  • SUMMARY: 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.[ncbi.nlm.nih.gov]
  • Treatments can control symptoms. They involve treating the heart or lung disease, medicines, oxygen, and sometimes lung transplantation.[icdlist.com]

Prognosis

  • OBJECTIVE: We performed a longitudinal transesophageal echocardiographic (TEE) study to determine whether this incidence, and its severe implications for prognosis, might have changed in our unit as we altered respiratory strategy.[ncbi.nlm.nih.gov]
  • OBJECTIVES: To determine the prevalence and prognosis of ACP and build a clinical risk score for the early detection of ACP.[ncbi.nlm.nih.gov]
  • We performed a longitudinal transesophageal echocardiographic (TEE) study to determine whether this incidence, and its severe implications for prognosis, might have changed in our unit as we altered respiratory strategy.[insights.ovid.com]
  • Several authors have emphasized the poor prognosis of this hemodynamic instability ( 30 , 32 ).[atsjournals.org]
  • ( 11505150 ) 2001 33 Acute cor pulmonale in acute respiratory distress syndrome submitted to protective ventilation: incidence, clinical implications, and prognosis. ( 11505125 ) 2001 34 Acute cor pulmonale in massive pulmonary embolism: incidence, echocardiographic[malacards.org]

Etiology

  • Our case represents one of the first reports of a rare etiology for acute cor pulmonale--hypersensitivity pneumonitis.[ncbi.nlm.nih.gov]
  • SUMMARY: 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.[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]
  • Etiology Classification of pulmonary hypertension (WHO) by cause Group 1: Pulmonary arterial hypertension ( PAH ) Group 2: Left heart disease (e.g. valvular heart diseases , left-to-right shunt) Group 3: Chronic lung diseases and/or hypoxemia COPD , emphysema[amboss.com]

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]
  • […] 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]
  • References: [3] Epidemiological data refers to the US, unless otherwise specified.[amboss.com]
  • The epidemiology of chronic thromboembolic pulmonary hypertension (CTEPH) is unknown.[what-when-how.com]
  • […] rapid increase of pulmonary arterial pressure resulting in RV overload, dysfunction, and potential cardiovascular collapse Chronic: progressive hypertrophy and dilation of the RV over months to years, leading to dysfunction, and potentially failure Epidemiology[unboundmedicine.com]
Sex distribution
Age distribution

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]
  • 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]
  • The pathophysiology of failure in acute right ventricular hypertension: Hemodynamic and biochemical correlations. Circulation 1981; 63:87–95. PubMed Google Scholar 10. Guyton A, Lindsey A, Gilluly J.[link.springer.com]
  • 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 Predisposing factors Natural history Pathophysiology[escardio.org]
  • Pathophysiology of pulmonary hypertension1. Hypoxic pulmonary vasoconstriction and arterial occlusion are the major causes of pulmonary hypertension.2. Both produce reduced blood flow with increased vascular resistance.3.[slideshare.net]

Prevention

  • 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]
  • Positive end expiratory pressure (PEEP) has been proven to help oxygenation by keeping diseased alveoli open, thus improving gas exchange and preventing atelectrauma.[atm.amegroups.com]
  • 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]
  • […] ventilation for acute respiratory distress syndrome: prevalence, predictors, and clinical impact. ( 26650055 ) Mekontso Dessap A....Vieillard-Baron A. 2016 6 Massive pulmonary embolism with acute cor pulmonale. ( 26984674 ) Nelson A.J....Parvar S.L. 2016 7 Preventing[malacards.org]

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