Symptoms and Clinical Manifestations of Cor Pulmonale: What You Need to Know

Cor pulmonale, a condition characterized by right-sided heart failure caused by lung disease, presents with a range of clinical symptoms that vary depending on the severity and progression of the underlying pulmonary disorder. In its early stages, patients often exhibit signs of chronic bronchitis, such as persistent coughing, excessive mucus production, and expectoration of yellowish sputum. As the disease advances, individuals may progress through a phase resembling emphysema, marked by increasing breathlessness, especially during physical exertion like climbing stairs or walking short distances.

Progression to Advanced Cor Pulmonale

As cor pulmonale worsens, symptoms of right heart failure become more prominent. These include systemic venous congestion due to impaired cardiac output. One key indicator is peripheral edema, particularly swelling in both lower limbs, which results from fluid accumulation in the tissues. This is often one of the first noticeable signs that prompt patients to seek medical attention.

Respiratory and Systemic Complications

In cases where carbon dioxide retention (hypercapnia) occurs due to poor gas exchange in damaged lungs, patients may develop additional complications. These can include conjunctival edema—swelling of the eye's outer membrane—giving the appearance of watery or "teary" eyes. Gastrointestinal symptoms are also common; congestion in abdominal organs can lead to poor appetite, nausea, and a general feeling of malaise.

Nighttime dyspnea—shortness of breath that worsens at night—is another hallmark symptom, often disrupting sleep and reducing quality of life. In severe episodes, patients might cough up pink, frothy sputum, a sign suggestive of pulmonary edema and acute decompensation. While this is less common in pure cor pulmonale compared to left-sided heart failure, it can occur during exacerbations of chronic obstructive pulmonary disease (COPD) or other acute respiratory events.

Diagnostic Indicators and Physical Examination Findings

During a clinical evaluation, healthcare providers look for specific physical signs that support the diagnosis. A positive hepatojugular reflux—where jugular vein distention increases when pressure is applied to the liver—is a strong indicator of right-sided heart strain. This reflects elevated central venous pressure due to impaired right ventricular function.

Imaging studies play a crucial role in confirming the diagnosis. Echocardiography typically reveals right ventricular hypertrophy—the thickening of the right ventricular wall—as the heart compensates for increased pulmonary vascular resistance. Additionally, computed tomography (CT) scans of the chest may show enlargement of the right ventricle and pulmonary artery dilation, further supporting the presence of chronic pulmonary hypertension leading to cor pulmonale.