Clinical Presentation

• The most common presenting complaints of patients with cor pulmonale is dyspnea on exertion and fatigue.
• Syncope, near syncope, chest pain, palpitations and leg edema are also common.
• Physical findings may be subtle early. Jugular venous pressures are invariably increased. Cardiac palpation may reveal a right ventricular heave. P2 is increased and moves closer to A2 as the pulmonary pressures increase. Eventually S2 may be fixed and paradoxically split. Increased right atrial pressures may lead to dependent edema, hepatojugular reflux, and ascites.
• The chest x-ray may reveal right ventricular hypertrophy, manifest as filling of the retrocardiac space on the lateral film, and increased PA size.
• The ECG may be normal or show right atrial and ventricular enlargement as well as an R axis deviation. Supraventricular tachycardias are common.