Sample Report: Death Summary: Cor Pulmonale
HISTORY: The patient, a 40-year-old male, was admitted through the emergency department after a syncopal episode at his place of employment. He has a history of emphysema and increasing dyspnea on exertion. He reported having intermittent night sweats and episodes of overwhelming fatigue over the past several weeks.
PHYSICAL EXAMINATION: At the time he was seen after admission, his temperature was normal at 98.6, respirations were 27 per minute, and pulse was 98 and regular. Blood pressure was 100/70. Jugular venous pressure was raised to 5 cm above the sternal angle, with prominence of the A waves. A right parasternal heave was present, and there was a loudpulmonic second heart sound. An ejection systolic murmur was heard in the pulmonary area. Pitting edema was present in the lower extremities.
X-RAY AND LABORATORY FINDINGS: Chest x-ray revealed an enlarged right ventricle, with prominent pulmonary conus. There was no obvious lung infiltrate. Pulmonary function tests revealed decreased diffusing lung capacity. There was no evidence of pulmonary embolism on ventilation/perfusion scan. Cross-sectional echocardiogram and Doppler studies revealed a significantly enlarged right atrium and ventricle with a dilated pulmonary artery and severe pericardial effusion.
Left and right cardiac catheterization revealed pulmonary hypertension with reduced cardiac output. There was also mild impairment of the left ventricle.
HOSPITAL COURSE: The patient suddenly became severely hypotensive and was transferred to theCCU for stabilization and monitoring. He received prednisolone, IV cyclophosphamide, captopril, furosemide, and plasmapheresis. He developed deep venous thrombosis for which he received warfarin.
Initially there appeared to be a somewhat overall improvement in his condition; however, on the second day in CCU he experienced cardiac arrest and, despite aggressive efforts, he was unable to be revived.
CAUSE OF DEATH: Cor pulmonale.