Objectives:

• Diagnose cor pulmonale
• Describe causes of cor pulmonale
• Treat a patient with cor pulmonale

1		Your “congestive heart failure couple,” as they now call themselves, are doing so well that the wife refers her cousin to you. Her cousin, a 65-year-old male, arrives at your office and you immediately notice the smell of tobacco leaching from his clothing. The small burns in his clothing confirm to you that he smokes, and he informs you that he has smoked 3 packs per day “since I was born.” He recently he has noticed some swelling in his feet and increased shortness of breath. He denies a history of cardiac disease. An ECG performed in the office shows right axis deviation and a right bundle branch block. An echocardiogram shows that he has normal left ventricular function but a hypertrophied right heart with paradoxical bulging of the ventricular septum into the left ventricle. This clinical picture is most consistent with which of the following?
			A)	Constrictive pericarditis.
			B)	Chronic mitral valve prolapse.
			C)	Cor pulmonale.
			D)	Old right ventricular infarction with subsequent dysfunction.
			E)	Atrial myxoma.
2		Cor pulmonale is the result of which of these processes?
			A)	Genetically determined muscular hypertrophy of the right ventricular muscle fibers.
			B)	Calcium influx dysfunction in the right ventricular musculature.
			C)	Chronic cocaine abuse.
			D)	Chronic amphetamine use.
			E)	None of the above.
3		Besides stopping smoking, the best treatment for this patient’s cor pulmonale and pulmonary hypertension is:
			A)	Continuous prostacyclin infusion.
			B)	Continuous, low-flow oxygen.
			C)	Calcium channel blockers (direct vasodilators to dilate the pulmonary vascular bed).
			D)	Nitroglycerin.
			E)	Antibiotics to reduce pulmonary inflammation secondary to infection.