Chest
Right Ventricular Dysfunction in Chronic Obstructive Pulmonary Disease*: Evaluation and Management
Section snippets
Normal RV Function
Assuming that there are no intracardiac shunts, RV output is equivalent to that of the LV, but because the PAP is much lower than systemic blood pressure, the design and performance of the two ventricles are quite different. The RV has a thin lateral free wall and a greater volume and surface area than the LV, making it a highly compliant chamber that better accommodates increases in filling pressure. Normally, the pulmonary circulation is a low pressure system maintaining a small pressure
CLINICAL EVALUATION
A careful history and physical examination are certainly important in the evaluation of any patient with COPD, but they lack sensitivity in the detection of RV dysfunction. The most common symptoms of RV dysfunction in COPD, increased dyspnea and diminished exercise tolerance, are difficult to differentiate from those resulting from the patient's airway obstruction alone. Physical signs of RV dysfunction may be difficult to detect in patients with COPD because of chest hyperinflation and a
MANAGEMENT OF COR PULMONALE IN PATIENTS WITH COPD
RV dysfunction in cor pulmonale is, by definition, secondary to chronic respiratory disease. Hence, initial therapy in patients with COPD should be directed at optimizing medical management of the patients airway obstruction. Therapy aimed at improving RV function requires identification of reversible factors that are contributing to increased RV afterload such as fluid overload, polycythemia, and hypoxic vasoconstriction.
SUMMARY
Cor pulmonale is an important consequence of COPD. Although the incidence is not precisely known, it is seen more frequently in patients with hypoxemia, CO2 retention and severely reduced FEV1. When present, it limits peripheral oxygen delivery, increases shortness of breath, and reduces exercise endurance. It is also associated with higher mortality rates independent of other prognostic variables. Numerous factors may contribute to the development of cor pulmonale in patients with COPD, but
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