Table 20: Common symptoms, signs and test results in right heart failure (RHF) without pulmonary hypertension and in cor pulmonale
Common features	RHF without pulmonary hypertension	Cor pulmonale
Symptoms	Hepatic congestion Right upper quadrant discomfort Anorexia/early satiety Peripheral edema Cough Shortness of breath/orthopnea*	Fatigue Hemoptysis Hoarseness Hepatic congestion Right upper quadrant discomfort Anorexia/early satiety Peripheral edema Cough Shortness of breath/orthopnea*
Physical signs	Elevated jugular venous pulsation, positive hepatojugular reflux or Kussmaul’s sign Peripheral or sacral edema Ascites Hepatomegaly or liver tenderness Right-sided third heart sound Murmur of tricuspid regurgitation Signs of right ventricular enlargement	Elevated jugular venous pulsation, positive hepatojugular reflux or Kussmaul’s sign Peripheral or sacral edema Ascites Hepatomegaly or liver tenderness Right-sided third heart sound, increased pulmonary closure sound, pulmonary ejection click Murmur of tricuspid regurgitation Signs of right ventricular enlargement Evidence of coexisting underlying pulmonary cause of cor pulmonale
Diagnostic testing	ECG: Right axis deviation, right ventricular hypertrophy, p pulmonale pattern low-voltage QRS, incomplete or complete right bundle branch block Chest x-ray: Right-sided cardiac enlargement, enlargement of pulmonary arteries (uncommon), oligemic peripheral lung fields (rare), right-sided pleural effusion* Echocardiography: Evidence of abnormal right ventriular structure and/ or function. No evidence of increased pulmonary pressure. Septal flattening during diastole but not systole	ECG: Right axis deviation, right ventricular hypertrophy, p pulmonale pattern low-voltage QRS, incomplete or complete right bundle branch block Chest x-ray: Right-sided cardiac enlargement, enlargement of pulmonary arteries, oligemic peripheral lung fields, right-sided pleural effusion* Echocardiography: Evidence of abnormal right ventricular structure and/or function. Evidence of increased pulmonary pressure. Septal flattening during systole

Items appearing in italics occur in the setting of cor pulmonale but are very uncommon in its absence.

*Less commonly found, but may occur. ECG Electrocardiogram

ECG, electrocardiogram; RHF, right heart failure.