Cor pulmonale vs Left heart failure
How to tell Cor pulmonale and Left heart failure apart when a board question makes them look alike.
Cor pulmonale starts in lung/pulmonary vessels and fails the RV; left HF starts in the LV and congests the lungs.
Side by side
Right ventricular hypertrophy/failure from primary lung disease or pulmonary vascular disease causing pulmonary hypertension.
LV systolic or diastolic dysfunction causing pulmonary venous congestion, orthopnea, crackles, pulmonary edema, and often secondary RV strain later.
Chronic hypoxic pulmonary vasoconstriction or pulmonary vascular disease increases RV afterload.
Elevated LV filling pressures transmit backward into pulmonary veins and capillaries.
COPD/interstitial lung disease/OSA with RV strain, loud P2, JVD, edema, and preserved LV function points cor pulmonale.
Reduced LV EF, S3, pulmonary edema, and elevated left-sided filling pressures point left heart failure.
The trap
Right-sided edema is not automatically cor pulmonale; LV failure is the most common cause of right-sided failure overall.
Watch it explained
The repair move
When RV failure appears, ask what raised RV afterload: lung disease or left heart disease.
Try a free question
CoreA patient with severe COPD develops pulmonary hypertension, right ventricular hypertrophy, JVD, hepatomegaly, and peripheral edema. Left ventricular systolic function is preserved. Which diagnosis is most likely?
Show answer and explanation
Answer: A. Cor pulmonale. Cor pulmonale is right ventricular enlargement/failure caused by lung disease or pulmonary vascular disease leading to pulmonary hypertension.
Why the other choices are tempting
- B. Left heart failure causes pulmonary venous congestion and pulmonary edema from LV dysfunction.
- C. Tamponade causes obstructive shock with pericardial pressure.
- D. Constrictive pericarditis causes impaired filling from a rigid pericardium.
- E. Nephrotic syndrome causes edema through protein loss, not RV failure from lung disease.
Flashcards
Tap a card to flip it.
What is the fastest separator for Cor pulmonale vs Left heart failure?
Cor pulmonale starts in lung/pulmonary vessels and fails the RV; left HF starts in the LV and congests the lungs.
What clue should make you choose Cor pulmonale?
Right ventricular hypertrophy/failure from primary lung disease or pulmonary vascular disease causing pulmonary hypertension.
Quick answers
What is the fastest way to tell Cor pulmonale from Left heart failure?
Cor pulmonale starts in lung/pulmonary vessels and fails the RV; left HF starts in the LV and congests the lungs.
What is the key clue for Cor pulmonale?
Right ventricular hypertrophy/failure from primary lung disease or pulmonary vascular disease causing pulmonary hypertension.
What is the key clue for Left heart failure?
LV systolic or diastolic dysfunction causing pulmonary venous congestion, orthopnea, crackles, pulmonary edema, and often secondary RV strain later.
What is the common trap with Cor pulmonale vs Left heart failure?
Right-sided edema is not automatically cor pulmonale; LV failure is the most common cause of right-sided failure overall.