Overview
Definition
Alteration in the structure and function of the right ventricle (RV) of the heart caused by a primary disorder of the respiratory system.
Epidemiology
A major complication of chronic lung diseases like COPD.
Etiology & Risk Factors
- COPD (most common cause)
- Pulmonary Hypertension
- Interstitial Lung Disease
- Obstructive Sleep Apnea
- Massive Pulmonary Embolism (acute cor pulmonale)
Clinical Symptoms
- Dyspnea on exertion
- Fatigue
- Exertional syncope
- Peripheral edema
- Right upper quadrant abdominal pain (hepatic congestion)
Clinical Approach
Diagnosis
- Echocardiogram: Right ventricular hypertrophy and dilation, tricuspid regurgitation
- ECG: Right axis deviation, Right Ventricular Hypertrophy (RVH), Right Bundle Branch Block (RBBB)
- Right Heart Catheterization (Gold Standard)
Management
- Treat the underlying pulmonary disease (e.g., Bronchodilators for COPD)
- Continuous oxygen therapy (improves survival by relieving hypoxic pulmonary vasoconstriction)
- Diuretics (cautiously, to reduce RV preload)
Complications
- Right-sided heart failure
- Severe peripheral edema
- Hepatic cirrhosis (cardiac cirrhosis)