ABSTRACT
The close interrelationship of the cardiovascular and the respiratory systems requires par ticular attention to the findings of the heart examination in evaluating a patient with respira tory complaints. In patients with chronic lung disorders, findings of cor pulmonale indicate the severity of the disorder and can be followed as a measure of the patient’s response to therapy. Left ventricular dysfunction and valvular disease, for example, may first present with respiratory symptoms of cough or dyspnea, or precipitate exacerbations in a patient with known chronic lung disease. On the other hand, physical exam evidence of right ventricular (RV) strain may be the only abnormal finding-and an important clue-in a patient who presents with dyspnea from primary pulmonary hypertension. Th£ review of a complete cardiovascular exam is beyond the scope of this chapter. Severe acute or chronic lung disease causes elevation of resistance in the pulmonary vascular bed, a conse quent rise in pulmonary artery (PA) pressure in an attempt to maintain flow, and ultimately RV decompensation. Thus, this discussion will focus on the physical findings related to elevated PA pressure and RV failure, the features of cor pulmonale. The interested reader is referred to a review of this topic by NS Hill, listed in the “ Suggested Reading,” and to Chap. 33. Table 5 summarizes these findings.
