Cor Pulmonale Echo Findings — RACP Adult Medicine MCQ

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EasyRespiratoryCor Pulmonale Echo FindingsRACP Adult Medicine

A 68-year-old man with severe COPD (FEV1 25% predicted) presents with peripheral oedema, raised JVP, and a loud P2. ECG shows right axis deviation, P pulmonale, and dominant R wave in V1. What echocardiographic finding is expected?

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Correct answer: B — Left atrial enlargement

Cor pulmonale (right heart failure secondary to chronic lung disease) presents with peripheral oedema, raised JVP, and signs of pulmonary hypertension (loud P2). ECG shows right heart strain (RAD, P pulmonale, dominant R in V1, RBBB). Echocardiography characteristically shows right ventricular dilation, tricuspid regurgitation, elevated RV systolic pressure (RVSP), and interventricular septal flattening (D-shaped LV). Left ventricular function is typically preserved. Treatment is LTOT (only proven survival benefit), diuretics for fluid overload, and treatment of the underlying lung disease.

Reference: eTG – 2025 – Respiratory; NHF/CSANZ – 2018 – Heart Failure Guidelines