Signs and Symptoms of Cor Pulmonale: What You Need to Know
Cor pulmonale, also known as pulmonary heart disease, is a condition characterized by the enlargement and failure of the right side of the heart due to chronic lung disorders. The clinical presentation of cor pulmonale varies significantly depending on whether the patient is in the compensated or decompensated phase of the disease. Understanding these differences is crucial for early detection, proper management, and improved outcomes.
Early Signs During the Compensated Phase
In the compensated stage, the heart is still able to maintain adequate circulation despite increased pressure in the pulmonary arteries. During this period, symptoms are often mild and may be mistaken for those of underlying respiratory conditions such as chronic bronchitis or emphysema.
Common early manifestations include persistent coughing and frequent sputum production, especially in individuals with long-standing lung diseases. Patients may also experience palpitations during physical activity, along with increasing shortness of breath when exerting themselves. A noticeable decline in exercise tolerance is another hallmark—simple daily tasks like climbing stairs or walking short distances become more challenging.
Symptoms Worsen in the Decompensated Phase
As the disease progresses into the decompensated phase, the right ventricle can no longer compensate for the elevated pulmonary pressure, leading to right-sided heart failure and respiratory insufficiency. This stage brings more severe and systemic symptoms that significantly impact quality of life.
Respiratory Failure and Its Effects
One of the most concerning developments is respiratory failure, which causes a marked worsening of dyspnea—even at rest. Breathing difficulties often intensify at night, disrupting sleep and frequently leading to insomnia. Low oxygen levels and high carbon dioxide retention in the blood can affect brain function, resulting in neurological complications collectively known as pulmonary encephalopathy.
Patients may exhibit mental status changes such as apathy, confusion, excessive drowsiness (somnolence), and in severe cases, delirium or even coma. These signs require immediate medical attention, as they indicate advanced disease and potential life-threatening complications.
Right-Sided Heart Failure Symptoms
When right heart failure develops, fluid begins to accumulate in the body due to impaired venous return. A classic sign is dependent pitting edema, particularly in the lower limbs—pressing on the swollen area leaves a temporary indentation.
Other symptoms include loss of appetite (anorexia), a persistent feeling of fullness or bloating in the abdomen, and nausea. These gastrointestinal issues arise from congestion in the liver and abdominal organs caused by backward pressure in the venous system. Some patients may also report abdominal discomfort or weight gain due to fluid retention.
Recognizing the progression from mild respiratory symptoms to systemic cardiac and neurological involvement is key in managing cor pulmonale effectively. Early diagnosis and treatment can help slow disease progression, relieve symptoms, and enhance patient well-being.