Moffitt Report Pearls 8/17: Cor Pulmonale!

EKG findings can include
  • RBBB
  • Right axis deviation
  • RV hypertrophy
    • Dominant R wave in V1/V2, prominent S waves in V5/V6
    • Small R waves and deep S waves across the precordium
  • RA enlargement
    • Increased amplitude of P wave in lead II or  P wave axis of >90 degrees
  • S1Q3T3 is the traditionally taught sign of acute cor pulmonale but is NOT sensitive
 
RV volume vs volume/pressure overload on echo
  • Flattening of the interventricular septum (D-shaped LV) during diastole alone: suggest RV volume overload
  • Flattening of the interventricular septum (D-shaped LV) during the entire cardiac cycle (esp in systole): suggests RV volume and chronic pressure overload. Usually the increased LV pressure during systole can overcome a flattened septum due to volume overload, but not if there is also pressure overload from a chronically overloaded RV!
  • Check out the flattened septum: https://www.youtube.com/watch?v=URRrnmgTYQ4
 
Can TB cause pulmonary HTN? (the case presented today was a patient with cor pulmonale, but chest CT is concerning for TB)
Unclear, but check out this paper from Harry of 14 cases for a discussion on this possible association (PMID 21339885)
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