Subacute cor pulmonale: Report of four cases

Abstract

Subacute cor pulmonale is a distinct clinical syndrome that is often not too easily diagnosed. Its salient features are (1) development of sudden dyspnea of a progressive nature; (2) absence of an underlying cardiopulmonary disorder to account for the dyspnea, or presence of such disorder in an asymptomatic phase; (3) paucity of physical signs in the chest to explain the dyspnea; (4) signs of failure of the right side of the heart developing later in the course of the disease; (5) lack of therapeutic response to the usual measures for congestive heart failure; (6) roentgenographic evidence of lymphangitic carcinomatosis or pulmonary embolization; (7) electrocardiographic abnormalities suggesting hypertrophy and dilatation of the right ventricle; and (8) a clinical course of only a few weeks or months. Inasmuch as an underlying thrombophlebitis or phlebothrombosis may be responsible for the development of pulmonary embolization, one of the causes of subacute cor pulmonale, it appears reasonable to suggest that anticoagulants be administered as soon as the presence of this condition is suspected. Such early prophylactic therapy may prevent a certain number of otherwise inevitable deaths.