Symptoms of Cor Pulmonale: Understanding the Signs During Compensated and Decompensated Phases

Cor pulmonale, a condition characterized by right-sided heart enlargement and failure due to chronic lung disease, presents with varying symptoms depending on whether the patient is in the compensated or decompensated stage. Recognizing these signs early can significantly improve treatment outcomes and quality of life.

Early Warning Signs in the Compensated Phase

During the compensated phase, the body attempts to adapt to reduced oxygen levels caused by underlying pulmonary disorders. Patients may experience mild but persistent respiratory symptoms such as chronic cough and sputum production—often linked to long-term bronchial irritation or conditions like chronic obstructive pulmonary disease (COPD).

As lung function gradually declines, individuals commonly report shortness of breath during physical activity, increased heart rate (palpitations), and a noticeable decrease in exercise tolerance. These signs are often overlooked or attributed to aging or poor fitness, delaying proper diagnosis.

Progression to the Decompensated Phase

When cor pulmonale progresses to the decompensated phase, the heart can no longer compensate for the strain imposed by chronic hypoxia and pulmonary hypertension. This stage is marked by acute respiratory failure and the onset of right-sided heart failure.

Worsening Respiratory Symptoms

Breathing difficulties become more severe, especially at night, frequently disrupting sleep patterns. Patients may develop orthopnea (difficulty breathing while lying flat) and rely on extra pillows to breathe comfortably. Insomnia and daytime fatigue are common due to nocturnal hypoxemia.

In advanced cases, low blood oxygen and high carbon dioxide levels lead to neurological complications known as pulmonary encephalopathy. This can manifest as confusion, apathy, disorientation, hallucinations, and even progression to stupor or coma if untreated.

Signs of Right-Sided Heart Failure

Right ventricular dysfunction results in systemic fluid retention. One of the most visible signs is pitting edema in the lower extremities—swelling that leaves an indentation when pressed.

Patients may also suffer from gastrointestinal symptoms such as loss of appetite, bloating, nausea, and abdominal discomfort due to liver congestion and impaired venous return. Jugular venous distention and hepatomegaly (enlarged liver) are clinical findings that further support the diagnosis.

Early detection and management of both respiratory and cardiac symptoms are crucial in slowing disease progression. Lifestyle modifications, oxygen therapy, medications, and treating the underlying lung condition play key roles in improving prognosis for individuals with cor pulmonale.