![]() RVH is characterized by a left parasternal or subxiphoid heave. Other cardiac findings include third and fourth sounds and the systolic murmur of tricuspid regurgitation. S2 heart sound splitting with an accentuated pulmonic component may be found early, while a systolic ejection murmur with sharp ejection click over the region of the pulmonary artery may be heard in advanced disease, along with a diastolic pulmonary regurgitation murmur. Wheezes and crackles may be audible upon auscultation due to underlying lung disease. Expected signs include an increase in chest diameter, labored respiratory efforts with retractions of the chest wall, distended neck veins with prominent a or v waves, and cyanosis. Physical exam findings reflect the underlying lung disease or pulmonary hypertension, right ventricular hypertrophy (RVH), and RV failure. Anorexia, right upper quadrant abdominal discomfort, and jaundice may occur due to passive hepatic congestion. Other symptoms include anginal chest pain (due to right ventricular ischemia), hemoptysis, and, rarely, hoarseness due to compression of the left recurrent laryngeal nerve by a dilated pulmonary artery. Common symptoms are fatigue, tachypnea, exertional dyspnea, and cough. In chronic cor pulmonale, right ventricular (RV) hypertrophy (RVH) generally predominates. Cor pulmonale usually presents chronically however, 2 main conditions can cause acute cor pulmonale: pulmonary embolism (more common) and acute respiratory distress syndrome (ARDS). It is estimated to account for 6-7% of all types of adult heart disease in the United States, with chronic obstructive pulmonary disease (COPD) due to chronic bronchitis or emphysema the most common cause (the causative factor in more than 50% of cases). Cor pulmonale is a change in the structure and function of the right ventricle and is caused by a primary disorder of the lungs or the pulmonary blood vessels. ![]() This patient's diagnosis is chronic cor pulmonale. Correct answer: Distended neck veins with prominent a or v waves Explanation The correct response is distended neck veins with prominent a or v waves.
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