Cor Pulmonale

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

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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

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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

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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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