Cardiac/Vascular Nurse Exam Secrets Study Guide Read Online Free PDF Page A

chronic obstructive pulmonary disease, or emphysema. Acute pulmonary embolism is the most common cause of death in patients with cor pulmonale. Of the 50,000 patients that die of acute pulmonary embolism in the United States, nearly half are associated with cor pulmonale. Of those patients with chronically evolving disease due to chronic obstructive pulmonary disease, 30% have a chance of surviving 5 years.
     

Causes
    Cor pulmonale is caused by any condition that leads to prolonged pulmonary hypertension and can occur secondary to an array of cardiopulmonary diseases. Chronic pulmonary diseases that can put patients at a predisposition for cor pulmonale include COPD, obstructive sleep apnea, central sleep apnea, cystic fibrosis, primary pulmonary hypertension, pneumoconiosis, kyphoscoliosis, interstitial lung disease, chronic thromboembolic pulmonary disease, pulmonary vascular disease and pulmonary hypertension.
     
    Acute causes of cor pulmonale include massive pulmonary embolization and exacerbation of chronic cor pulmonale.
     
    Chronic causes of cor pulmonale include COPD, loss of lung tissue due to trauma or surgery, Pierre Robin sequence and end stage pneumoconiosis.
     
    Cor pulmonale is caused by several mechanisms including pulmonary vasoconstriction, anatomic changes in vascularization, increased blood viscosity, and idiopathic or primary pulmonary hypertension.
     

Symptoms
    The symptoms associated with Cor Pulmonale are typically nonspecific and can be associated with a variety of cardiopulmonary diseases. The symptoms of the disease also depend on whether the disease presents chronically or acutely due to pulmonary embolism or acute respiratory distress syndrome.
     
    The symptoms of cor pulmonale include shortness of breath, coughing, wheezing, swelling of feet and ankles, fluid retention, exercise intolerance, tachypnea, hemoptysis, labored respiratory efforts with retractions of chest wall, hoarseness and chest pain or discomfort. Additionally, neurological symptoms may occur due to decreased cardiac output and hypoxemia.
     

Screening and diagnosis
    Physical examination and diagnostic screening tools are typically used to diagnose cor pulmonale. Patients typically present with a bluish hue to their skin as well as distension of the neck veins caused by elevated right side heart pressures. Other indicators of the disease include abnormal fluid collection in abdomen, liver enlargement, increased chest diameter, prominent a or v waves, cyanosis, ankle and foot swelling as well as abnormal heart sounds.
     
    Diagnostic tools used to diagnose the disease include echocardiogram, chest x-ray, CT scan, pulmonary angiography, magnetic resonance imaging, ECG-gated CT scanning, pulmonary function tests, ventilation/perfusion lung scans, arterial blood gas measurements, antibody testing and brain natriuretic peptide measurements. Additionally, more invasive diagnostic approaches include Swan-Ganz catheterization and lung biopsy.
     
    Type I, II and Gestational Diabetes Mellitus
     
    Type I diabetes occurs in approximately 10% of all cases of diabetes mellitus. The condition can affect both adults and children, but is referred to as juvenile diabetes because it typically affects adolescents. The incidence of type I diabetes is approximately 15 cases per 100,000 individuals annually.
     
    Type II diabetes is the most common type of diabetes mellitus, approximately 90% of all cases of diabetes mellitus. Additionally, more than half of patients diagnosed with type II diabetes are obese. It is also more common in patients over 40 years of age, but can occur in young adults and adolescents. It is also more prevalent in Hispanics, Native Americans, African Americans, and Asians/Pacific Islanders than in Caucasians.
     
    Gestational diabetes occurs in approximately 2% to 5% of all pregnancies and is treatable with careful supervision throughout pregnancy. Of those women affected with gestational diabetes, approximately 20%