Diagnosis of Cor pulmonale
Cor pulmonale Diagnosis: Book Excerpts
Diagnostic Tests for Cor pulmonale: Online Medical Books
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Cor pulmonale:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
❑ Pulmonary artery pressure measurements show increased right ventricular and pulmonary artery pressures, stemming from increased pulmonary vascular resistance. Right ventricular systolic and pulmonary artery systolic pressures will exceed 30 mm Hg. Pulmonary artery diastolic pressure will exceed 15 mm Hg.
❑ Echocardiography or angiography indicates right ventricular enlargement; echocardiography can estimate pulmonary artery pressure while also ruling out structural and congenital lesions.
❑ Chest X-ray shows large central pulmonary arteries and suggests right ventricular enlargement by rightward enlargement of the heart’s silhouette on an anterior chest film.
❑ Arterial blood gas (ABG) analysis shows decreased partial pressure of arterial oxygen (PaO2; typically less than 70 mm Hg and usually no more than 90 mm Hg on room air).
❑ Electrocardiogram frequently shows arrhythmias, such as premature atrial and ventricular contractions and atrial fibrillation during severe hypoxia; it may also show right bundle-branch block, right axis deviation, prominent P waves and inverted T wave in right precordial leads, and right ventricular hypertrophy.
❑ Pulmonary function tests show results consistent with the underlying pulmonary disease.
❑ HCT is typically greater than 50%.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Pulmonary hypertension:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
Characteristic diagnostic findings include:
❑ Auscultation reveals abnormalities associated with the underlying disorder.
❑ Arterial blood gas (ABG) analysis indicates hypoxemia (decreased partial pressure of arterial oxygen).
❑ Electrocardiography shows right axis deviation and tall or peaked P waves in inferior leads in the patient with right ventricular hypertrophy.
❑ Cardiac catheterization reveals pulmonary systolic pressure above 30 mm Hg as well as increased pulmonary artery wedge pressure (PAWP) if the underlying cause is left atrial myxoma, mitral stenosis, or left-sided heart failure (otherwise normal).
❑ Pulmonary angiography detects filling defects in pulmonary vasculature such as those that develop in patients with pulmonary emboli.
❑ Pulmonary function tests may show decreased flow rates and increased residual volume in underlying obstructive disease and decreased total lung capacity in underlying restrictive disease.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Cor pulmonale:
Diagnosis
(Handbook of Diseases)
Pulmonary artery pressure (PAP) measurements show increased right ventricular and PAPs as a result of increased pulmonary vascular resistance. Right ventricular systolic and pulmonary artery systolic pressures will exceed 30 mm Hg. Pulmonary artery diastolic pressure will exceed 15 mm Hg.
❑ Echocardiography or angiography indicates right ventricular enlargement, and echocardiography can estimate PAP.
❑ Chest X-ray shows large central pulmonary arteries and suggests right ventricular enlargement by rightward enlargement of cardiac silhouette on an anterior chest film.
❑ Arterial blood gas (ABG) analysis shows decreased partial pressure of arterial oxygen (Pao2) less than 70 mm Hg.
❑ Electrocardiography frequently shows arrhythmias, such as premature atrial and ventricular contractions and atrial fibrillation during severe hypoxia; it may also show right bundle-branch heart block, right axis deviation, prominent P waves and an inverted T wave in right precordial leads, and right ventricular hypertrophy.
❑ Pulmonary function tests show results consistent with the underlying pulmonary disease.
❑ Hematocrit is commonly greater than 50%.
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Source: Handbook of Diseases, 2003
Pulmonary hypertension:
Diagnosis
(Handbook of Diseases)
Characteristic diagnostic findings in patients with pulmonary hypertension include the following:
❑ auscultation: abnormalities associated with the underlying disorder
❑ arterial blood gas (ABG) analysis: hypoxemia (decreased partial pressure of oxygen)
❑ electrocardiography: in right ventricular hypertrophy, shows right-axis deviation and tall or peaked P waves in inferior leads
❑ cardiac catheterization: increased PAP — pulmonary systolic pressure above 30 mm Hg; pulmonary artery wedge pressure (PAWP) increased if the underlying cause is left-sided myxoma, mitral stenosis, or left-side failure — otherwise normal
❑ pulmonary angiography: detects filling defects in pulmonary vasculature, such as those that develop in patients with pulmonary emboli
❑ pulmonary function tests: in underlying obstructive disease, may show decreased flow rates and increased residual volume; in underlying restrictive disease, total lung capacity may decrease.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Pulse pressure, widened:
History
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
Obtain the patient’s history, including a family medical history. Obtain a drug history. Has he experienced chest pain, shortness of breath, weakness, fatigue, or syncope? Ask the patient whether he recently had a fever. Ask about prolonged exposure to hot weather, excessive exercise, anxiety, or anemia.
Physical examination
Assess the patient for signs and symptoms of heart failure, such as crackles, dyspnea, and jugular vein distention. Check for changes in skin temperature and color and strength of peripheral pulses. Evaluate the patient’s LOC. Auscultate the heart for the presence of a murmur, and check for peripheral edema.
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Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007
Pulse pressure, widened:
History
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Obtain the patient’s medical, family, and drug histories. If you don’t suspect increased ICP, ask about such associated symptoms as chest pain, shortness of breath, weakness, fatigue, or syncope.
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Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
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