Diagnosis Of Chronic Cor Pulmonale Research Articles

STUDY CLINICAL, RADIOLOGICAL, ELECTROCARDIOGRAPHIC, AND ECHOCARDIOGRAPHIC CHANGES IN CHRONIC CORPULMONALE

Introduction: Chronic cor pulmonale accounts for 5–10% of all heart diseases and 20–30% of all admissions for heart failure. The development of pulmonary hypertension (PAH) and subsequent chronic cor pulmonale increases the risk of hospitalization and is associated with reduced survival. Echocardiography examination can quantify the extent of the right ventricular hypertrophy (RVH) and PAH noninvasively. Methods: This is a prospective and observational study conducted in 74 included cases admitted in the department of general medicine, NSCB Medical College Hospital, Jabalpur. On the basis of patient’s history, physical findings, radiological findings, and electrographic changes, the diagnosis of chronic cor pulmonale was made and was subjected to echocardiography examination. Results: Cor pulmonale was more common in smokers with male-to-female ratio of 2.52:1 and was more common in the 4th, 5th, and 6th decade of life. ECGshowed 58.10% of cases with RVH, 59.45% with right axis deviation, 48.64% right bundle branch block, and 66.21% with P pulmonale. Echocardiographic evaluation revealed right ventricular dilatation in 100% cases, RVH in 94%, tricuspid regurgitation in 52.70%, right atrial enlargement in 50%, PAH in 97.29%, diastolic septal flattening in 16.21%, paradoxical motion of the IV septum in 8.1%, reduced left ventricular end-diastolic volume in 8.1%, and left ventricular ejection fraction reduced in 22.97%. Conclusion: Detection of chronic cor pulmonale in the early stage is important for therapeutic and prognostic implication. Echocardiography is a non-invasive, affordable investigation for early diagnosis of chronic cor pulmonale.

Cardiac arrhythmias in highlanders with a diagnosis of chronic cor pulmonale

Antecedentes El corazon pulmonar cronico (CPC) muestra un incremento en habitantes que viven en grandes altitudes. Objetivo Investigar la frecuencia de arritmias cardiacas y factores de riesgo para su desarrollo. Metodos Estudio descriptivo y transversal; se reviso el registro de pacientes internados del Departamento de Cardiologia del Instituto Nacional de Torax, La Paz, Bolivia, entre enero de 2017 y junio de 2018; se incorporo a todos los individuos con diagnostico de CPC, definido por criterios clinicos, electrocardiograficos y ecocardiograficos; se incluyo a 162 pacientes que cumplieron los criterios en el analisis; se utilizaron la t de Student y ANOVA. Resultados Arritmias: fibrilacion auricular (FA), 125 (75%); aleteo auricular (AA), 17 (10.5%); taquicardia auricular (TA), 17 (10.5%); extrasistoles, 3 (1.9%). Segun el analisis univariado, los factores relacionados con el desarrollo de arritmias fueron: eritrocitosis: FA, RR: 1.33, otras arritmias (RR: 1.67), p = 0.0001; hipertension arterial pulmonar: FA, RR: 3.10, otras arritmias (RR: 3.21), p = 0.0001; dilatacion de auricula derecha (AD): FA, RR: 1.92, otras arritmias (RR: 2.13), p = 0.0001; obesidad: FA, RR: 3.47, p = 0.001, otras arritmias (RR: 3.70), p = 0.001; hipertension arterial sistemica: FA, RR: 3.10, p = 0.001, otras arritmias (RR: 3.21), p = 0.001. Segun el analisis multivariado: eritrocitosis (RR: 2.2), dilatacion de AD (RR: 1.2), p = 0.0001. Conclusiones Se encontro FA con mayor frecuencia en los pacientes con CPC; los factores de riesgo con mayor significancia estadistica para su presentacion fueron la eritrocitosis y la dilatacion de la AD. Background Chronic cor pulmonale (CPC), with increased presentation in high-altitude inhabitants. Objectives Investigating the frequency of cardiac arrhythmias, and risk factors for its development. Methods Descriptive, cross-sectional study, the inpatient registry of the Department of Cardiology of the National Institute of Torax, La Paz-Bolivia, from January 2017 to June 2018 was reviewed, all were incorporated with the diagnosis of CPC, defined by clinical criteria, electrocardiographic and echocardiographic, 162 patients who met the criteria were taken, the student’s t-test and ANOVA were used for the analysis. Results Arrhythmias: atrial fibrillation (AF) 125 (75%), atrial flutter (AA) 17 (10.5%), atrial tachycardia (AT) 17 (10.5%), extrasystoles 3 (1.9%). Univariate analysis of factors related to the development of arrhythmias: erythrocytosis: FA, RR: 1.33, other arrhythmias RR: 1.67, p = 0.0001, pulmonary arterial hypertension: FA, RR: 3.10, other arrhythmias RR: 3.21, p = 0.0001, right atrial dilation (AD): FA, RR: 1.92, other arrhythmias RR: 2.13, p = 0.0001, obesity: FA, RR: 3.47, p = 0.001, other arrhythmias RR: 3.70, p = 0.001, systemic arterial hypertension: FA: RR: 3.10, p = 0.001, other arrhythmias RR: 3.21, p = 0.001. Multivariate analysis: erythrocytosis (RR: 2.2), AD dilation (RR: 1.2), p = 0.0001. Conclusions AF was found more frequently in patients with CPC, the risk factors with the greatest statistical significance for presentation were: erythrocytosis and AD dilation.

English

BACKGROUND AND OBJECTIVES: To study the clinical profile, radiological features, electrocardiographic and echocardiographic changes in clinically proven cases of chronic cor pulmonale. METHODS: 50 patients who were diagnosed to have chronic cor pulmonale based on the inclusion criteria were selected from the medical wards of Adichunchanagiri Hospital and research centre, over a period of 2 years In all the selected patients detailed history and physical examination was noted and chest x-ray PA, 12 lead ECG and echocardiogram done. RESULTS: Among 50 patients admitted with chronic cor pulmonale, 45 were males and 5 were females. The peak incidence was found in the 4th, 5th and 6 th decades of life. Smoking was found to be a major cause for COPD and hence cor pulmonale. Among 50 patients 43 were smokers. Among 50 cases, (60%) were diagnosed to have chronic bronchitis with or without emphysema. Chest x-ray showed details relevant to the clinical profile. ECG showed 46% cases with RVH, 64% with RAD, 26% RBBB and 70% with P pulmonale. Every patient showed echocardiographic features suggesting chronic cor pulmonale except 3 patients who showed global hypokinesia. DISCUSSION AND CONCLUSION: Many patients who had chronic cor pulmonale were found to have COPD as the underlying disease. Majority of the male patients were smokers in the present study. Echocardiogram was found to be a better diagnostic tool. Though ECG and chest x-ray can support the diagnosis, ECHO can be used as a non invasive, affordable investigation for accurate and early diagnosis of chronic cor pulmonale.

Lengthy Diagnostic Challenge in a Rare Case of Pulmonary Veno-Occlusive Disease: Case Report and Review of the Literature

Pulmonary veno-occlusive disease (PVOD) is a rare and usually survival poor disorder. We report a patient with a long history of progressive dyspnea of over 8 years, who with a diagnosis of chronic cor pulmonale confirmed elsewhere, was ultimately diagnosed as PVOD via histological analysis of a lung biopsy. After treatment with combined bosentan, diuretics and digoxin, his symptoms and function improved. This case highlights that PVOD is an under-recognised and often misdiagnosed disease, especially in its chronic form. Understanding its pathogenesis, its poor response to medical therapy and its dismal prognosis remain challenges for the treatment of PVOD.

Chronic cor pulmonale secondary to pulmonary atherosclerosis in an African Grey parrot

A 20-year-old sexually intact female African Grey parrot (Psittacus erithacus) was evaluated to determine the cause of lethargy, hyporexia, weight loss, and persistent ascites of 21 days' duration. Physical examination revealed a markedly distended abdomen and systolic heart murmur. Thoracic radiography revealed cardiomegaly and hepatomegaly. Doppler echocardiography revealed severe eccentric and concentric hypertrophy of the right ventricle with systolic dysfunction, moderate regurgitation through the right atrioventricular valve, a substantial increase in estimated systolic pulmonary arterial pressure, hepatic venous congestion, and coelomic effusion. A clinical diagnosis of chronic cor pulmonale was established. The parrot was initially stabilized by use of coelomocentesis. During the next month, the parrot was treated by administration of furosemide, hydrochlorothiazide, spironolactone, benazepril, and pimobendan. The parrot appeared to be responding well to treatment but was found dead in its cage 35 days following initial examination. Postmortem examination revealed substantial atherosclerosis of the large pulmonary arteries, with lesions extending into the medium-size arteries. Pulmonary atherosclerosis was suspected as a cause of the severe pulmonary hypertension. Although atherosclerosis most commonly affects the systemic and coronary arteries of parrots, sclerotic changes within the pulmonary vasculature should be considered as a possible cause of pulmonary hypertension and as a differential diagnosis for right-sided congestive heart failure in psittacine species.

In-Hospital and 2-Year Survival of Patients Treated With Mechanical Ventilation for Acute Exacerbation of COPD

To analyze in-hospital and 2-year survival of patients who require mechanical ventilation with intubation after acute respiratory failure due to exacerbation of chronic obstructive pulmonary disease (COPD). The secondary objective was to identify the prognostic factors for in-hospital mortality and mortality at 2 years. We retrospectively studied 101 patients with suspected COPD admitted to the intensive care unit between July 1993 and December 1998. Variables potentially related to mortality were analyzed with a univariate model and by logistic regression. In-hospital survival was 74.3% and 2-year survival was 55.4%. Survival at 2 years was 81% for patients discharged from hospital. The variables associated with in-hospital mortality were age greater than 65 years, electrocardiographic diagnosis of chronic cor pulmonale, and development of multiorgan dysfunction syndrome. No factors predictive of mortality at 2 years were identified. The in-hospital survival rate for patients with an acute exacerbation of COPD who require mechanical ventilation is good and the 2-year survival rate is acceptable. Age, electrocardiographic signs of cor pulmonale, and development of multiorgan dysfunction syndrome were associated with greater risk of in-hospital mortality.

Cor pulmonale and pneumoconiotic lung disease: an investigation using hospital discharge data.

Cor pulmonale has been reported in the past to be associated with pneumoconiosis as an end-stage complication. However, whether the association can be demonstrated among cases of pneumoconiosis acquired in more recent decades is not clear. We examined the relation between these conditions using data summarized in hospital records in Ontario for males discharged between 1979 and 1990 with a diagnosis of chronic cor pulmonale or one of the pneumoconioses. Based on the age-specific frequency rates, cor pulmonale was diagnosed 17 (95% confidence interval 13-22) times more frequently than expected among men diagnosed with pneumoconiosis than among other men admitted to hospital. Our investigation indicates that cor pulmonale still appears to be associated with dust exposure in the workplace, and it demonstrates the usefulness of hospital discharge information in addressing questions in occupational health. However, we recommend that hospital medical records be examined to confirm the diagnoses and to determine the smoking histories of these men.

Chronic cor pulmonale

Chronic cor pulmonale is defined as right heart hypertrophy and/or chronic right heart failure. There are many etiologies, but the common cause is increased right heart work from pulmonary hypertension. Etiology can be conveniently discussed by assuming two prototypes, the asphyxial or hypoxic type and the vascular obliterative type. A common cause of the asphyxial type is chronic obstructive pulmonary disease, and the obliterative type is represented by chronic pulmonary thromboembolic disease or primary pulmonary hypertension. Pathology is discussed, emphasizing the cardiac manifestations of chronic cor pulmonale including data of specific cardiac chamber size. An overview of hemodynamics is given, and the use and limitation of electrocardiography and chest x-rays are discussed. The exciting potential use of echocardiography for the serial noninvasive measurement of anatomical and pathophysiological features is outlined, along with the value of a careful physical examination and the proper utilization of laboratory tests in the diagnosis of chronic cor pulmonale. In the patient with the asphyxial type, the treatment of pulmonary infectious exacerbations, the role of corticosteroids, digoxin, diuretics, phlebotomy, bronchodilators (theophylline, beta adrenergic agonists, and anticholinergics), and long-term oxygen therapy is noted. The controversy surrounding the use of vasodilators and calcium blockers in these patients is discussed. Treatment aspects of the vascular obliterative type, including the role of vasodilators, calcium blockers, prostacyclin, anticoagulants, and overall strategy are discussed. A brief note is mentioned of the promising role of surgical therapy in chronic thromboembolic disease causing chronic cor pulmonale.

Assessment of the clinical value of impedance pulmonary rheogram in the early diagnosis of cor pulmonale

The impedance pulmonary rheogram (IPR) and its first derivation of 83 patients with chronic cor pulmonale (CCP) and 50 healthy persons were measured and analyzed. The results indicated that the following parameters are valuable in the diagnosis of CCP: 1. Q-b interval ≥ 0.15 sec; 2.RVET ≤ 0.28 sec; 3. Q-b/RVET ratio ≥ 0.46; 4. Q-b index ≥ 0.17; 5. Q-C interval ≥ 0.20 sec; 6. wave amplitude ≤ 0.15 ohm. When any three of the above-mentioned six indices are positive, the patient may be diagnosed as CCP. According to this standard the rate of early diagnosis of CCP was 73.6%.

The usefulness of thallium-201 myocardial perfusion scintigraphy in the diagnosis of chronic cor pulmonale.

To open up the possibility of exact clinical diagnoses of chronic cor pulmonale, we performed thallium-201 myocardial perfusion scintigraphy on patients with chronic pulmonary disease. From the thallium activity in the left ventricle (plus ventricular septum) and right ventricle counted scintigraphically, we determined the thallium activity ratio of left to right ventricle (TAR). The intra- and inter-observer variations of this ratio were negligible. We compared TAR with pulmonary hemodynamic findings and with left to right ventricular mass ratio measured at autopsy, and obtained the following results. 1) Left to right ventricular mass ratio determined in 11 autopsied patients by the method of Fulton et al. was closely correlated with TAR values (r = 0.90, p less than 0.001). 2) In patients with chronic pulmonary disease, there were highly significant exponential inverse correlations between TAR and pulmonary arterial mean pressure, total pulmonary vascular resistance and right ventricular systolic pressure the the coefficients of -0.75, 0.72 or -0.77, respectively (p less than 0.001). These results suggested the possibility that the severity of pulmonary circulatory disturbance may be ascertained non-invasively by TAR measurement. Thus, thallium-201 myocardial perfusion scintigraphy is able to reveal non-invasively right ventricular hypertrophy in patients with chronic pulmonary disease, and it might be a useful means of clinically diagnosing chronic cor pulmonale. If TAR obtained from scintigrams is smaller than 2, the patient concerned may possibly have right ventricular hypertrophy and he or she may be diagnosed as having chronic cor pulmonale.

Studies on electrocardiogram of right ventricular hypertrophy in chronic cor pulmonale

The clinical diagnosis of chronic cor pulmonale has not yet been easy. The right heart catheterization is too cumbersome as a routine test, hence the clinical diagnosis of chronic cor pulmonale is usually based on the electrocardiogram using the various electrocardiographic criteria for the estimation of right ventricular hypertrophy. However, these criteria, except one reported by the World Health Organization (hereafter abbreviated as WHO), were set up from the cases with anatomical right ventricular hypertroyhy due to chronic cor pulmonale and others. In this study, the electrocardiograms from 24 cases of autopsy-comfirmed chronic cor pulmonale were analysed in order to evaluate the diagnostic value of various electrocardiographic criteria for the diagnosis of right ventricular hypertrophy due to chronic cor pulmonale. The influence of coexisting hypertrophy on the right ventricular hypertrophy pattern was also examined. Materials and Methods Twenty-four cases employed in this study died at the Keio University Hospital from chronic pulmonary diseases and/or pulmonary dysfunction. At postmortem study, all of them had definite right ventricular hypertrophy and were diagnosed pathologically as chronic cor pulmonale. Right ventricular thickness greater than 4 mm and left ventricular thickness greater than 15mm were defined right and left ventricular hypertrophy, respectively. Combined ventricular hypertrophy was present in 6 of 24 cases. Their age ranged between 25 and 83 years, with an average of 49 years. There were 17 males and 7 females. The underlying diseases were pulmonary tuberculosis (10 cases), chronic pulmonary emphysema (3 cases), pulmonary tuberculosis and chronic pulmonary emphysema (3 cases), bronchiectasis and chronic pulmonary emphysema (3 cases), bronchiectasis (2 cases), pulmonary fibrosis (1 case), pulmonary cyst (1 case), and chronic pulmonary emphysema and pulmonary cancer (1 case). These diagnoses were based on pathological findings.

Diagnosis and management of chronic cor pulmonale.

Diagnosis of chronic cor pulmonale often is difficult, particularly when caused by emphysema, because the distended lung conceals cardiac signs. When the condition is secondary to pulmonary fibrosis and primary pulmonary hypertension, characteristic signs are elicited more easily. The chest x-ray and electrocardiogram frequently are diagnostic in moderately advanced cor pulmonale resulting from primary pulmonary hypertension but are of little help when the basis is ventilatory insufficiency. Studies of arterial blood gases closely reflect ventilatory insufficiency. Pulmonary function tests assist in choice of therapy by elucidating the specific deject. Treatment of chronic cor pulmonale resulting from pulmonary vascular disease is largely ineffective. Therapy is more successful when the condition is secondary to ventilatory insufficiency. Simultaneous use of many agents often is necessary.

Heart Disease of Pulmonary Origin

It behooves clinical investigators in a University Hospital group to survey from time to time, recorded clinical material on pressing diagnostic and therapeutic problems. Heart disease of pulmonary origin is a pertinent and pressing topic for, when fully developed, it has been considered hopeless by too many physicians. We have, therefore, reviewed our cases in an attempt to reemphasize precipitating and perpetuating conditions, determine predisposing factors and evaluate early diagnostic signs. We hope to touch upon possible prophylactic measures and argue for the establishment of as effective a program of management as possible. We first studied the records of 208 cases, who had been cross filed under the diagnosis of chronic cor pulmonale. It soon became apparent that minimal criteria for the diagnosis of chronic cor pulmonale had to be established, and after considerable study we arrived at those set down in Table I. We were acutely aware that chronic cor pulmonale is an end result of an insidious process. Furthermore we were fully conscious of the difficulty of arbitrarily drawing a line separating definite cor pulmonale from pulmonary disease with positional electrocardiographic changes. The application of our criteria, as outlined here, has limited our study to patients with definite respiratory disease and pulmonary hypertension, and definite right atrial and right ventricular enlargement; as shown by the electrocardiogram or the teleradiogram. In addition, we have accepted the presence of right heart failure, without left failure, as presumptive evidence of right ventricular enlargement, even when other signs were equivocal. Patients with tricuspid or pulmonary valvular

The Q-T interval in chronic cor pulmonale.

In 13 patients in whom the diagnosis of chronic cor pulmonale was made after careful physiologic studies, the Q-T interval was found to be within normal limits regardless of the presence or absence of cardiac failure. The finding is in sharp contrast to the prolongation of this interval in the more common types of heart disease, as exemplified by a group of 14 patients with hypertensive and arteriosclerotic heart disease. Measurement of the Q-T interval therefore may be useful in differentiating pure chronic cor pulmonale from other types of heart disease with congestive failure.