Pulmonary hypertension and cor pulmonale

This article is directed primarily to primary care physicians. The challenge is to suspect, diagnose, and treat pulmonary arterial hypertension when treatment is most effective and before the effects of cor pulmonale become fully manifested. A good history and physical examination should be followed by electrocardiographic and roentgenographic evaluations. Of additional value are arterial blood gas measurements, two-dimensional echocardiography, first-pass radionuclide angiography, and catheterization of the right ventricle. Chronic obstructive pulmonary disease (COPD) is one of the more common etiologies of pulmonary hypertension and cor pulmonale. COPD is most common in the elderly and cor pulmonale is fairly common among those with COPD; therefore, hypoxic pulmonary hypertension and the resultant cor pulmonale occur mostly in older patients. Because early signs are nonspecific, diagnosis and treatment are often delayed until the pulmonary disorder is severe. Thus it is imperative that the primary care physician be cognizant of this serious problem. Standard treatment of left ventricular failure (ie, "congestive heart failure") could have adverse effects in patients with cor pulmonale.