What are symptoms of advanced cor pulmonale?

Updated: Dec 15, 2017
  • Author: Derek Leong, MD; Chief Editor: Henry H Ooi, MD, MRCPI  more...
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Answer

Answer

In advanced stages, passive hepatic congestion secondary to severe right ventricular failure may lead to anorexia, right upper quadrant abdominal discomfort, and jaundice. In addition, syncope with exertion, which may also be seen in severe disease, reflects a relative inability to increase cardiac output during exercise with a subsequent drop in the systemic arterial pressure.

Elevated pulmonary artery pressure can lead to elevated right atrial, peripheral venous, and capillary pressure. By increasing the hydrostatic gradient, it leads to transudation of fluid and accumulation of peripheral edema. Although this is the simplest explanation for peripheral edema in cor pulmonale, other factors may contribute, especially in a subset of patients with chronic obstructive pulmonary disease (COPD) who do not have an increase in right atrial pressure. A decrease in glomerular filtration rate (GFR) and filtration of sodium as well as stimulation of arginine vasopressin (which decreases free water excretion) by hypoxemia may play important pathophysiologic roles in this setting and may even have a role for peripheral edema in patients with cor pulmonale. [8]


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