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Lehrman S et al Primary pulmonary hypertension and cor pulmonale Cardiol Rev 2002 Sep Oct;10(5):265 78 [PMID: 12215190] Morrison LK et al Utility of a rapid B-natriuretic peptide assay in differentiating congestive heart failure from lung disease in patients presenting with dyspnea J Am Coll Cardiol 2002 Jan 16;39(2):202 9 [PMID: 11788208]

Polycythemia is often present in cor pulmonale secondary to COPD The arterial oxygen saturation is often below 85%; PCO2 may or may not be elevated

The ECG may show right axis deviation and peaked P waves Deep S waves are present in lead V6 Right axis deviation and low voltage may be noted in patients with pulmonary emphysema Frank RVH is uncommon except in idiopathic pulmonary hypertension The ECG often mimics myocardial infarction; Q waves may be present in leads II, III, and aVF because of the vertically placed heart, but they are rarely deep or wide, as in inferior myocardial infarction Supraventricular arrhythmias are frequent and nonspecific The chest radiograph discloses the presence or absence of parenchymal disease and a prominent or enlarged RV and PA

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Primary cardiac tumors are rare and constitute only a small fraction of all tumors that involve the heart or pericardium The most common primary tumor is atrial myxoma; it comprises about 50% of all tumors in adult case series It is generally attached to the atrial septum and is more likely to affect the LA than the RA Familial myxomas occur as part of the Carney complex that consists of myxomas, pigmented skin lesions, and endocrine neoplasia Patients with myxoma can present with the characteristics of a systemic illness, with obstruction of blood flow through the heart, or with signs of peripheral embolization The characteristics include fever, malaise, weight loss, leukocytosis, elevated sedimentation rate, and emboli (peripheral or pulmonary, depending on the

Pulmonary function tests usually confirm the underlying lung disease The echocardiogram should show normal LV

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