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The pathophysiology of pulmonary heart disease (cor pulmonale) has always indicated that an increase in right ventricular afterload causes RV failure (pulmonary vasoconstriction, anatomic disruption/pulmonary vascular bed and increased blood viscosity are usually involved [1]), however most of the time, the right ventricle adjusts to an overload in chronic pressure.
An ECG may show signs of right heart strain or acute cor pulmonale in cases of large PEs – the classic signs are a large S wave in lead I, a large Q wave in lead III, and an inverted T wave in lead III (S1Q3T3), which occurs in 12–50% of people with the diagnosis, yet also occurs in 12% without the diagnosis. [73] [74]
Right-sided heart failure is often caused by pulmonary heart disease (cor pulmonale), which is typically caused by issues with pulmonary circulation such as pulmonary hypertension or pulmonic stenosis. Physical examination may reveal pitting peripheral edema, ascites, liver enlargement, and spleen enlargement.
An important potential finding with echo is McConnell's sign, where only the RV apex wall contracts; [7] it is specific for right heart strain and typically indicates a large PE. [8] On an electrocardiogram (ECG), there are multiple ways RV strain can be demonstrated. A finding of S1Q3T3 [b] is an insensitive [10] sign of right heart strain. [11]
Characteristic peaked P wave of cor pulmonale. Peaked P waves (> 0.25 mV) suggest right atrial enlargement, cor pulmonale, (P pulmonale rhythm), [1] but have a low predictive value (~20%). [2] A P wave with increased amplitude can indicate hypokalemia. [3] It can also indicate right atrial enlargement. [4]
Right Atrial Enlargement (RAE) increases the p wave, representing atrial depolarization, on an ECG to an amplitude > 2.5mm in lead II, an abnormality referred to as p-pulmonale, likely due to weakened right atrial myocardium close to the Sinoatrial (SA) node.
The next addition to the historical understanding of pulmonary circulation arrived with the Ancient Greeks. Physician Alcmaeon (520 – 450 BCE) proposed that the brain, not the heart, was the connection point for all of the vessels in the body. He believed that the function of these vessels was to bring the "spirit" ("pneuma") and air to the ...
Such dilatation is most often due left heart failure or pulmonary hypertension. Other causes of right ventricular dilatation include right ventricular infarction, inferior myocardial infarction, and cor pulmonale. [3] In regards to primary and secondary causes they are: [9] Pathological specimen and ultrasound image of a heart with Ebstein's ...
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