Signs Of Cor Pulmonale Research Articles

A Full Term Infant with Cyanotic Episodes

A Full Term Infant with Cyanotic Episodes

The nineteenth pregnancy in a patient with cor pulmonale and severe pulmonary hypertension: A management challenge

The nineteenth pregnancy in a patient with cor pulmonale and severe pulmonary hypertension: A management challenge

Floating right heart thrombi and pulmonary embolism: diagnosis, outcome and therapeutic management.

The aim of this study was to analyze clinical and echographic findings and to assess therapeutic management in 14 floating right atrial thrombi diagnosed with systematic echocardiography in 200 consecutive patients with proven pulmonary embolism. Auscultatory findings were abnormal in 7 cases, 4 of them showing signs of tricuspid obstruction. Echocardiography displayed a mobile ovoid, polycyclic or worm-like right atrial mass, always associated with signs of cor pulmonale. Four patients (29%) died, 2 of them before any treatment could be started. Regarding the remaining 10 patients with favorable outcome, surgical embolectomy was carried out in 7. Our data suggest that echocardiographic examination is necessary in all suspected pulmonary embolisms and has to be done quickly for emergency treatment in patients with floating right atrial thrombus.

Prognostic Factors in COPD Patients Receiving Long-term Oxygen Therapy: Importance of Pulmonary Artery Pressure

Prognostic factors in COPD patients receiving long-term oxygen (LTO) therapy were recently analyzed, but very few studies considered the prognostic value of pulmonary artery pressure (PAP) in these patients. We investigated 84 patients who had undergone a right heart catheterization just before the onset of LTO. There were 75 men and 9 women, with a mean age of 63.0 +/- 9.9 (SD) years, at the onset of LTO. When PaO2 was persistently less than 55 mm Hg, LTO was initiated. This therapy was started in some patients with PaO2 in the range of 55 to 60 mm Hg if they had signs of cor pulmonale or a resting PAP of 25 mm Hg or greater at right heart catheterization. The daily duration of LTO was 16 h/d or more. Oxygen flow was adapted to achieve a PaO2 of 65 mm Hg or more. The patients were subdivided into subgroups according to the median value of age (cutoff value = 63 years); vital capacity (2,250 mL); FEV1 (800 mL); residual volume-total lung capacity ratio (58%); PaO2 value (52 mm Hg), PaCO2 level (45 mm Hg); and PAP (25 mm Hg). The cumulative 5-year survival rate was 48% for the group as a whole. Actuarial survival curves were plotted for the two subgroups of patients subdivided according to the initial median value of the variables just listed. There was no significant difference in survival rate between subgroups except when taking into account the level of PAP and age. In patients with an initial PAP of 25 mm Hg or less (n = 44), the 5-year survival was of 62.2 vs 36.3% in the remainder (n = 40) [p < 0.001]. We performed a multivariate analysis of survival using Cox's model of the proportional hazards regression including sex and the variables with the same categorization in the stepwise procedure: PAP and age were the only variables included in the final model. We conclude that the best prognostic factor in COPD patients receiving LTO is not the FEV1, nor the degree of hypoxemia or hypercapnia, but the level of PAP.

Severe Pulmonary Hypertension with Diffuse Smooth Muscle Proliferation of the Lungs: Pulmonary Tuberous Sclerosis?

A 49-year-old man with normal intelligence and no cutaneous lesions had symptoms and signs of cor pulmonale. The chest roentgenogram showed an interstitial pattern. Hemodynamic studies revealed increased pulmonary arterial and wedge pressures. The patient died in shock, and the postmortem findings were a diffuse smooth muscle proliferation in the lungs as the cause of the pulmonary hypertension. We presume that this is a form of pulmonary tuberous sclerosis of which few cases are reported with such severe pulmonary hypertension as shown by our measurements.

Pulmonary tumor embolism

Pulmonary tumor embolism is a common finding at autopsy but is generally perceived as a difficult diagnosis to make ante mortem. After a retrospective review of 164 reported cases of pulmonary tumor embolism, we identified a typical profile of clinical, laboratory, and imaging features that may permit confident clinical diagnosis in most patients with this condition. The clinical features include a documented or suspected underlying malignancy, acute to subacute onset of dyspnea, and signs of cor pulmonale. Supportive laboratory features are hypoxemia or increased alveolar-arterial oxygen gradient, and invasive or noninvasive evidence of pulmonary artery hypertension. Typical imaging findings are normal chest radiographs; multiple, subsegmental, peripheral perfusion defects on ventilation-perfusion lung scans; and delayed filling with or without subsegmental filling defects but without a thrombus on pulmonary angiogram. Radiolabeled monoclonal antibody imaging and pulmonary microvascular cytology sampling techniques are promising diagnostic tests for early diagnosis of pulmonary tumor embolism.

Respiratory Insufficiency in Adult-Onset Acid Maltase Deficiency

Although the adult form of acid maltase deficiency is characterized by weakness of the limb girdle muscles, weakness of the respiratory muscles out of proportion to that of the limb muscles may make the diagnosis less obvious. We present four patients aged 35 to 57 with respiratory muscle weakness associated with signs of cor pulmonale and symptoms of alveolar hypoventilation. Each had symptoms of fatigue, hypersomnolence, morning headache, and orthopnea, the cause of which was misdiagnosed. The key to diagnosis was paradoxic abdominal motion on inspiration. This finding, consistent with diaphragmatic paralysis, led to neurologic evaluation, electromyographic examination, and muscle biopsy to confirm the diagnosis. The symptoms of alveolar hypoventilation were reversed with chronic nocturnal ventilation, which assisted in rehabilitating some patients.

Cardiopulmonary Changes Secondary to Chronic Adenotonsillitis

Thirty children with lower respiratory tract infection of varying degrees secondary to chronic tonsillitis and/or enlarged adenoids were studied clinically and roentgenographically. Symptoms and signs of alveolar hypoventilation and signs of cor pulmonale were present in two of them. These symptoms and signs improved markedly after adenoidectomy and tonsillectomy. The relationship of the lung changes to the incidence of cor pulmonale is discussed. The development of recurrent attacks of severe lower respiratory tract infection secondary to diseased tonsils and adenoids is believed to play an important role in the pathogenesis of cor pulmonale in children with upper respiratory tract obstruction due to chronically enlarged tonsils and adenoids.

Electrocardiographic signs of cor pulmonale in asbestosis

A cross-sectional study examining the prevalence of electrocardiographic (ECG) signs of cor pulmonale and their correlation with ventilatory capacity was carried out with 130 asbestosis patients and 121 referents. The ventilatory function of 120 of the 130 patients was measured, 41 having a normal FEV1.0, 50 slight FEV1.0 impairment and 29 moderate or severe FEV1.0 impairment. The cor pulmonale signs were more prevalent in the asbestosis than in the reference group, the greatest differences being found in PII,III,aVF amplitude, PV1 amplitude, ÂQRS deviation to the right and shift of QRS transition to the left. These differences were not, however, statistically significant. The frequencies of electrocardiographic cor pulmonale findings in the three FEV1.0 categories of asbestosis patients were established. The atrial parameters PII,III,aVF, ÂP, and PV1 correlated the best with FEV1.0, but only the relationship PV1/FEV1.0 was significant (P<0.05). Most of the ventricular ECG parameters failed to show any association with FEV1.0, especially SV5,6 amplitude, which has displayed a strong positive correlation with FEV1.0 in many studies dealing with obstructive lung diseases, and terminal notching of QRS. The present study suggests that the atrial ECG variables are the most valuable items for assessing right heart disease in patients with asbestosis.

Chondrosarcoma of the Pulmonary Artery

Primary sarcomas of the large vessels are rare. They are observed most commonly in the pulmonary artery. Up to now 28 cases of primary sarcoma of the pulmonary artery have been described in the literature. The clinical features of this disease which presents considerable diagnostic difficulties are dominated by signs of cor pulmonale. In the present paper a primary chondrosarcoma of the pulmonary artery is presented.

Cor pulmonale due to tumor emboli; review of literature and report of a case.

A 35-year-old woman, 9 months after a radical mastectomy for carcinoma of the left breast, developed severe dyspnea, with other symptoms and signs of cor pulmonale. She died 3 weeks after the onset of the dyspnea. A chest roentgenogram made shortly before death was negative, and gross examination at autopsy revealed no definite emboli in the pulmonary vessels. The right ventricle, however, showed slight hypertrophy, and on microscopic examination many of the smaller pulmonary arteries and arterioles were found to contain solid clusters of malignant cells. It is suggested that the development of cor pulmonale in patients with malignant tumors may give warning of metastatic activity in time for the physician to institute palliative chemotherapy.