COR PULMONALE

CHIEF COMPLAINT

Cor pulmonale

HPI

SYMPTOM LIST

• Fatigue
• Tachypnea
• Exertional dyspnea
• Cough
• Angina
• Chest pain
• Hemoptysis
• Hoarseness
• Anorexia
• Right upper quadrant abdominal discomfort
• Syncope
• Peripheral edema

SEVERITY
• Mild
• Moderate
• Severe
• Absent
• Normal
• Increased
• Decreased
• Stable
• no significant change from prior visit

HISTORY (PMFSH)

PAST HISTORY

• Massive pulmonary embolization

• Exacerbation of chronic cor pulmonale
• COPD
• Loss of lung tissue following trauma or surgery
 • Pierre Robin sequence
• End stage Pneumoconiosis
• Sarcoidosis
• Repeated pulmonary emboli
• Pulmonary vasculitis
• Pulmonary veno-occlusive disease
• Congenital heart disease with left-to-right shunting
• Sickle cell disease
• High altitude disease with pulmonary vasoconstriction
• Primary pulmonary hypertension
• Interstitial lung diseases
• Chronic obstructive lung diseases
• Neuromuscular disorders
• Myasthenia gravis
• Poliomyelitis
• Amyotrophic lateral sclerosis
• Obstructive and central sleep apnea
• Kyphoscoliosis
• Diabetes
• Hypertension
• Cancers

ALLERGY-Drugs
-Environment

FAMILY HISTORY

• Diabetes
• Hypertension
• Heart diseases
• Connective tissue diseases
• Sarcoidosis
• COPD

SOCIAL HISTORY

Habits

• Alcohol
• Tobacco
• Drugs___
Occupation____

ROS

PHYSICAL EXAMINATION

On Inspection
• An increase in chest diameter
• Labored respiratory efforts with retractions of chest wall
• Distended neck veins with prominent a or v waves
• Cyanosis
On Auscultation of the lungs
• Wheezes
• Crackles
• Systolic bruits in the lungs.
On Auscultation of the heart
• Splitting of the second heart sound with accentuation of the
pulmonic component
• Systolic ejection murmur with sharp ejection click
• Diastolic pulmonary regurgitation murmur
• Third and fourth sounds of the heart
• Systolic murmur of tricuspid regurgitation.
• A left parasternal
• A left subxiphoid heave
• Hepatojugular reflex
• Pulsatile liver
On Percussion
• Hyper resonance of the lungs
• Ascites

TESTS TO BE ORDERED

Blood tests
• CBP
• Hb%
• Hematocrit value
• Serum alpha1-antitrypsin
• Antinuclear antibody level
• Serum levels of proteins S and C
• Antithrombin III
• Factor V Leyden
 • Anticardiolipin antibodies
• Homocysteine
Urinalysis
o Macroscopic
 Urine Bilirubin
 Urine Blood
 Urine Casts
 Urine Color
 Urine Glucose
 Urine Ketones
 Urine pH
 Urine Protein
 Specific Gravity
 Urine Urobilinogen
o Microscopic
 Urine WBS/hpf
 Urine RBC/hpf
 Urine Casts
 Urine Other

Chest radiography
ECG
Echocardiography
Pulmonary function tests
Chest CT scan
Right heart catheterization
Arterial blood gas tests
Brain natriuretic peptide (BNP)
Doppler echocardiography
Ventilation/perfusion (V/Q) lung scan
Pulmonary angiography
Ultrafast, ECG-gated CT scan
MRI
Radionuclide ventriculography
Lung biopsy

ASSESSMENT/PLAN & INSTRUCTIONS/EDUCATION

Oxygen therapy

Surgical Care:
• Phlebotomy
• Uvulopalatopharyngoplasty
 • Single-lung transplantation
• double-lung transplantation
• heart-lung transplantation

MEDICATION

• Amlodipine
• Azelnidipine
• Barnidipine
• Benidipine
• Cilnidipine
• Efonidipine
• Felodipine
• Lacidipine
• Lercanidipine
• Manidipine
• Nicardipine
• Nifedipine
• Nilvadipine
• Nimodipine
• Nisoldipine
• Nitrendipine
• Pranidipine
• Verapamil
• Gallopamil
• Diltiazem
• Acetyldigitoxin
• Acetyldigoxin
• Bufanolide
• Cardenolide
• Daigremontianin
• Digoxin
• Lanatoside C
• Medigoxin
• Ouabain
• Peruvoside
• Proscillaridin
• Acenocoumarol
• Acid-citrate-dextrose
• Ancrod
• Anisindione
 • Apixaban
• Ardeparin
• Argatroban
• Bivalirudin
• Brodifacoum
• Certoparin
• Coumatetralyl
• Dabigatran
• Dalteparin
• Danaparoid
• Defibrotide
• Dicoumarol
• Draculin
• Enoxaparin
• Fondaparinux
• Hementin
• Heparin
• Hirudin
• Lonomia
• Otamixaban
• Phenindione
• Phenprocoumon
• Pindone
• Policosanol
• Pulvinone
• Rivaroxaban
• Warfarin
• Ximelagatran
• Ambrisentan
• Bosentan
• Sitaxsentan
• Theophylline
• Methylxanthine
• Furosemide

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