What are the physical findings characteristic of cor pulmonale?

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

Physical findings may reflect the underlying lung disease or pulmonary hypertension, right ventricular hypertrophy (RVH), and RV failure. An increase in chest diameter, labored respiratory efforts with retractions of the chest wall, distended neck veins with prominent a or v waves, and cyanosis may be seen.

On auscultation of the lungs, wheezes and crackles may be heard as signs of underlying lung disease. Turbulent flow through recanalized vessels in chronic thromboembolic pulmonary hypertension [9] may be heard as systolic bruits in the lungs. On percussion, hyperresonance of the lungs may be a sign of underlying COPD.

Splitting of the second heart sound with accentuation of the pulmonic component can be heard in the early stages. A systolic ejection murmur with a sharp ejection click over the region of the pulmonary artery may be heard in advanced disease, along with a diastolic pulmonary regurgitation murmur. Other findings upon auscultation of the cardiovascular system may be RV third and fourth sounds or the systolic murmur of tricuspid regurgitation.

RVH is characterized by a left parasternal or subxiphoid heave. Hepatojugular reflux and pulsatile liver are signs of RV failure with systemic venous congestion. In severe disease, ascites can also be present.

Examination of the lower extremities reveals evidence of pitting edema. Edema in cor pulmonale is strongly associated with hypercapnia. [10]


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