Mandatory medical device diagnostics.
- Electrocardiogram (ECG; recording of the electrical activity of the heart muscle) – Change in ECG usually occurs late or is absent in a large proportion of patients. The following change may occur in cor pulmonale:
- Right heart hypertrophy sign (sign of right heart enlargement):
- Elevation of the R-wave in leads V1 and V2.
- Increase of the S-wave in leads V5 and V6 to > 0, 7 mV.
- Right ventricular repolarization dysfunction:
- ST depressions and T negativities in leads V1-V3.
- Criteria with low specificity (probability that actually healthy individuals who do not have the disease in question are also identified as healthy by the procedure):
- Right bundle branch block with a deformation of the ventricular complex in chest wall leads V1, V2, and a negative T in V1 to V3.
- Pyramidal P pulmonale (P wave is broadened and elevated) in limb lead III
- Right heart hypertrophy sign (sign of right heart enlargement):
- X-ray of the thorax (X-ray thorax/chest), in two planes – changes also show up very late in this case. The following changes may occur in cor pulmonale:
- Right heart hypertrophy, the heart fills the retrosternal space in the lateral image.
- Prominent pulmonary arch (truncus pulmonalis).
- Dilated central pulmonary arteries, caliber jump towards peripheral arteries → peripheral “bright lung“.
- Echocardiography (echo; cardiac ultrasound) – to measure tricuspid regurgitation (leakage leading to backflow of blood from the right ventricle into the right atrium) and the so-called TAPSE (abbreviation for: “tricuspid annular plane systolic excursion”); this allows an indirect estimation of systolic pulmonary arterial pressure; measurement of TAPSE is done by M-mode and describes the longitudinal excursion of the tricuspid valve during systole/contraction phase of the heart (< 2 cm = pulmonary hypertension/pulmonary hypertension).
- Right heart catheterization; using the right heart catheter, right ventricular pressure (pressure in the right ventricle) can be determined at rest and under stress.
Optional medical device diagnostics – depending on the results of the history, physical examination, laboratory diagnostics and obligatory medical device diagnostics – for differential diagnostic clarification.
- Abdominal ultrasonography (ultrasound examination of the abdominal organs) – for basic diagnostics.
- Computed tomography of the thorax/chest (thoracic CT) – for advanced diagnostics.
- Perfusion/ventilation scintigraphy
- Cardiac catheterization
