Signs of enlargement of the right ventricle (RV) may be attributed to mild-to-moderate pulmonary hypertension (PHTN) that is common in severe obstructive bronchitis and emphysema.  Pulmonary artery systolic pressure is typically in the range of 50 to 60 mmHg, far below the systemic levels that may occur in patients with congenital heart disease and in those with primary pulmonary hypertension. ⁵  

Note:  The investigating registered nurse should be aware that patients with cor pulmonale due to “chronic obstructive lung disease” (COLD), usually have an advanced form of the disease with FEV₁ < 1.0 L and Pа₀₂ < 60 mmHg.  Also, the RV failure secondary to COLD often occurs when there is “acute-on-chronic” respiratory failure with evidence of hypoxemia.⁶       

Laboratory Examinations for Evidence Based -  

    The electrocardiogram (ECG) will often show sinus tachycardia (Sin tach) or atrial fibrillation (AFib), ventricular arrhythmias, and left atrial abnormalities.  Also, look for diffuse non-specific ST-T wave abnormalities and sometimes an intraventricular conduction defect (IVCD), with global low voltage criteria.  These are all electrical nodal signs of possible pre-cardiomyopathy.  Next, order a complete 2-D echocardiography and radionuclide- ventriculography, which my show left ventricular dilatation, with normal or minimally thickened or thinned walls, along with systolic dysfunction (reduced ejection fraction).   

Note:  The nurse-clinician should investigate, identify, and document, then forward these signs and symptoms to the primary physician, in order for possible further investigation into ordering a cardiac catheterization and/or coronary angiography.  In many case studies reported within the U.S. patients who pursue an inexorably down-hill course, and those who are over 55 years of age, die within 3 years of the onset of symptoms. ⁷

  History Taking Protocols –    

     Patients with hypertrophic cardiomyopathy (HCM) may indeed appear A-symptomatic.  The nurse and/or practitioner should be able to detect and document some of the signs and symptoms which can include dyspnea, syncope, pre-syncope, angina, palpitations, orthopnea, paroxysmal nocturnal dyspnea, dizziness, congestive heart failure, and through atopy findings, in sudden cardiac death. 

Dyspnea –

Syncope –   

Pre-Syncope –

Note:  After your findings and documentation as an investigating nurse- clinician, consult with the cardiologist and/or electro-physiologist for possible specific cardiac studies which should include the non-invasive cardio-diagnostic department, to run either a Frank- vector-cardiogram or Single-Average (e.g., late potential diagnostics).   Like syncope, pre-syncopal episodes warrant a direct evaluation to rule-out (R/O) malignant arrhythmias.  A thorough investigation is warranted to also, R/O potential malignant etiology of pre-syncopal symptoms.¹⁰ʹ11

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